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� c <br /> PERMIT APPLICATION <br /> BUILDINGIMECHANICAL/PLUMBING/SIGN/SPRINKLERIDEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES �I �-�6�� Z <br /> 3200 Cedar St., Everett,WA 98201 -425-257-8810-FAX 425-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITEADURESS: PROPERNTAXp P RMI7A _r,y.� <br /> p GYzt r�c� w <br /> LE6AL for new conslructlon: Sho�t PlaVsubdivision Lol No._ (altach copy of long legal desalpllon) <br /> OWNER S U�' S�i � � PhonelE•mall <br /> / H_ � g, / <br /> ddresa Z �'�Z'e. r// ciry�sie��zia Lv�A ' � d"Z9� <br /> CONTRACTOR i(i+ 6^l�� /A L 8 I Lic.iF <br /> dAress f�/ �Zr!'r'�� ��LU'� PhnnelEmail <br /> TENA T BUSINESS NAME CONiACT FOR PERMIT <br /> PhonUE•mail <br /> BUILDING PERMIT APPLICA'f10N CONTRACT PRICE OF WORK <br /> HEAT SOURCE: <br /> Existing Usa of Building <br /> Proposed Use of Building Gae Eleclric Olher <br /> Buildingtype: _S(ngleFamily _Dupiez_ Townhouse _Mulll•Family _Commercial . <br /> TypaofproJecL• _New _Addilion _,Rer,iodel _Repair_T.I._Sfgn_Sprfnkler_Demolitlon_Change ofUse <br /> Desulptlon of Work(addifional space provided on fhe back): <br /> Have you ataRed working wilhout a permlt4 YES _NO . <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> TypeolProJecl: _New_Addn _Alteration_Repelr TypeolProject: _Naw_Addn _Allantlon_Repalr <br /> ShowNumber(N)o/Oxfures ShowNumber o/flrtuns <br /> AIC—airhandlin units Toilet <br /> Forced air s stems Bathtub <br /> Gas i In Lavato wash bas(n <br /> Water healer Shower <br /> Gas fire lace Kitchen sfnk 8 dis osal <br /> Gas ran a Dishwesher <br /> Cblhesd er Cblheswasher <br /> Ran e hood Water heater <br /> Exhaustfan Sink serv(ce/bar/mo /etc. <br /> Heat um Backflow reventer <br /> Unit healer Udnal <br /> Boiier �rinkin Founleln <br /> Refd eration Floordrain <br /> Woodslove Grease tra <br /> Ductin Roof drains <br /> Other Medlcal Gas <br /> SPRINKLER/SUPPRESSION SYSTEM other: <br /> Number of Heads Olher: <br /> 1 hereDy cerlify Ihal 1 havn read and examined thls appliwlion and kncw Ihe same to Ee Irue and wrrat.All provisbns ol lews and ordinance�goveming <br /> thls type ol xrork will be complied with whelher specified herefn or nat.7Ae granlinp ol a permit dces nat presume lo give aWwrity to Woiale or cencel <br /> the provision ol any other slale or locel law regulattng consiNclbn or the peAormance ol consWclion.That I em authoilzed by lhe ownerof thb popetly <br /> lo peAorm l� fa wfiich�pli��s made and I camp wil�lhe Stale Contracloro law iB.27 RCW and 288.400 WAC <br /> i/ <br /> i �` �`���' �� l-�i �O'/L �Ra�;,�avm�+� <br /> Ow arlAuthorized Agent Signalure <br /> ' ° oate <br />