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� <br /> PERMIT APPLICATION <br /> BUILDINGIMECHANICAUPLUMBINGISIGNISPRINKLER/DEMOLoITION <br /> CITY OF EVERETT PERMIT SERVICES ��`�a `I( <br /> 3200 Cedar St., Everett, WA 98201 -425-257-8810-FAX 425-257-8857-www.everetlwa.org <br /> APPLICATIONS ARE ACCEPTED FROM!AM TO�PM <br /> SITE ADDRESS: vrtor[an n►x e P IT R � � <br /> �� t-� t-t�� 14 � <br /> LE6AL for new consiruction: Shoh PlaUsubdivision Lot No._ (atlach copv o11on0 legal desctlption) <br /> OWNER (_-. �, Phone/E•mail <br /> AdCress CitylStete/Zip <br /> CONTRACTOR lJG 'Z p L 61 Lic.# G� <br /> naaress 3 I(> L(�(,�� � U� 1�v'l Cr+ Z� PhonelEmali ;j (j .. - �'lZ`f <br /> TENAN7 BUSINESS NAME CONTACT FOR PERMIT <br /> PhonelE-mail ��(J � � J ���� ` <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK 9� S Sc�G•�� <br /> Existing Use of Building HEAT SUURCE: <br /> Proposed Use of 8uilding Gas e�earic other <br /> Building lype: _Single Family �/ Duplex_Townhouse _Multi-Family _Commercial <br /> Type of project: _New _Addition _Remodel _Repair_T.I._Sign_Sprinkler_Demolition_Change ot Use <br /> Descnption oi Work(addifional spaca provided on fhe back): <br /> Have you etarted working without a permit9 _YE3 _NO <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type ol Projxl: _Nsw_AAAn _Alteretlon_Repair Typs o}ProJstt: _Nsw_Addn _Ak�ntloa_R�pdr <br /> Show Number(N)o//irtures Show Numbsr(/)o/flrtuni <br /> F/C-air handlin units Toilet <br /> Forced air s stems Bathtub <br /> Gas ipin Lavato (wash basin) <br /> Water heater Shower <br /> Gas Oreplace Kitchen sink&dis osal <br /> Gas ran e Dishwasher <br /> Clothes d er Clothea washer <br /> Ran e hood Water heater <br /> Exhaust tan Sink(service�badmo /etc. <br /> Heal pump Backflow reventer <br /> Unit heater Urinal <br /> Boiier Drinkin Fountain <br /> Refrigeration Floor drain <br /> Woodstove Grease tra <br /> Ductin Rooi dreins <br /> Other Medical Gas <br /> 8PRINKLER / 3UPPRESSION SYSTEM other: <br /> Z.. � Number of Heads Other. <br /> I hereby ceAify�hal 1 have read and ezamined Ihis application and know ihe same lo be true and conect.All provisions ot�aws and ordinances goveminp <br /> this type o1 work will be complied wi�h whether specified herein or no�.The granting ol e permit Ooes nol presume lo give authority to vioiale or cancel <br /> the provision of any olher state or local Iaw regulating conslruction or Ihe peAormance ol conslruction.That I am authorized by Ihe owner ot�his propeAy <br /> to peAorm�/the work for which applicalion is made and I comply vnth ihe State Con�radors Lew 18.27 RCW and 298.200 WAC <br /> !ic � 1 �=��[/� S �G�` lI <br /> OwnerlAuthodzed Agent Signature Date (Revised 2R0f f�Yi. <br />