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C - <br /> PERM17 APPLICATION <br /> BUILDING/MECHANICAUP'LUMBiNG/SIGNISPRINKL ER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett,WA 98201 -425-257-8810—FAX 425-257-8857—www•everettwa.org r I <br /> APPLICATIONS ARE ACCEPTED FROM 6 AM TO 4 PM !O '��� <br /> SITE ADDRESS: PROPERTY T/U(N PERM T i <br /> a � a ' "1 � { ►t7- o Z <br /> LEGAI-lot new construc�ion: Short PlaVsubdivision Lol No._ (atlach copy of IonB Ie�ai desc:iplion) <br /> OWNER f ,\ . Phene/E-mail <br /> Address ,S Q� C Gt "hQ� A City/5tale2ip . n <br /> CONTRACTOR '" . V{{� L 8 I Lic.# S 1 O N vl <br /> Address �s� U �. �-1cA PhonelEmail �NZS� 7�0 ��� �2' <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT �L�� ������( <br /> Fhone/E-mail 4zS) 7(n '��� �l <br /> BUILDING PERMIT APPLICATION CmNTRACT PRICE OF WORK � � -� <br /> E:cisting Use of Building_ S��'-J1-��r� HEAT SOURCE: <br /> Propose�]Use of Building �� �� ,_ Gas Electric_ Other_ <br /> Building type: .�Sing�e Family _Duplex Townhouse _Multi-Family _Commercial <br /> Type oi orojecl: _Naw _Addition __Remodel ,_Repair_T.i.,_Sign_Sprinkler_Demolition_Change o(Use <br /> Descfip�ion of Work(edditional space provl,fed on fhe back): t� <br /> R�� �as Irn�e '�,r Hv�-c� ho�- u�:,,k� �Y�`= � � P�� � <br /> Have yau started working wilhout a pertnit7 _YES �NO / <br /> INECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATiON <br /> Type of WroJect: New_Addn _Alterotlon_Repalr Type o1 Projeet: _New_Addn _Alteratlon_Rapair <br /> Show Number(N)o/�xtures _Show Number(N)o/flxfures <br /> A/C—air handlin unils Toilet <br /> Forced air s stems Bathtub <br /> Gas pi in Lavato (wash basin) <br /> Water heater Shower <br /> Gas firepiace Kitchen sink 6 dis osal <br /> Gas ran e Dishwasher <br /> Clothes d er Clothes washer <br /> Range hood N'aler heater <br /> Exhausl fan � Sink(service/barlmop/etc.) <br /> Heal pump Backilow reventer <br /> Unil heater Urinal <br /> Boiler Drinkin Fauntain <br /> Retri era�ion Floor drain <br /> Woodstove Grease ira <br /> Ductin Root drains <br /> Other Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM Other: <br /> Number of Heads Other: <br /> I hereby certify Ihal I have read end exemined this applicallon and know t�e same to be true and cortect.All provisions of laws and ordinances 8oveming <br /> Ihis type of work will be complied with whelher spedfie,d herein or nol.The granting oi e permit does not presume lo give authority lo violate or cancel <br /> the provision of any ott�er stale or lowl Iaw regulating construclion or�he perfortnance of cons�ruclion.That I am au�horized by�he owner oi lhis propeMy <br /> to pertorm Iha w rk for��hic plica�ion is made and I�comply with ihe Slate Coolractors Law 18.27 RCW and 296200 WAC <br /> �4 ' I iu u <br /> OwnerlA ho � ge i n lure Dale /RevisedYlONJ <br /> �.� <br />