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PERMIT APPL.ICATION <br /> BUILDINGIMECHANICAL/PLUMBlNG/SIGN/SPRINKLLR/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett,W A 98201 -425-257-8810— FAX 425-257-8857 —www.everettwa.o/rg <br /> APPLICATIONS ARE ACCEPTED FROh1 8 Ah7 TO 4 Pht fp—� <br /> SITEA�DRESS: � PROPERTYTN(M PERht1TF�� O�) <br /> LEGAL for new conslrvclion: Snort PlaVsubdivision Lo1 ho._ (attach copy al Iong le9al descripC:an) <br /> OWNER 5/(� Rw5a1� PhonelE�mai��{Z 3rjrj —C� <br /> Address �3 L Gty/Slate/Zip ��; (( �/4, 3 <br /> CONTRACTOR � e � } L&I Lic. # <br /> Address PhonciEmall <br /> TENANT BUSINE55 NA67E CONTACT FOR PERMIT <br /> PhoneiE-ma�l <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK 3r70O _ <br /> Exisling Use of Huildiny HEAT SOURCE: <br /> ProposeAUseo(Building Gas____ Eiectnc O;ner_ _ <br /> Building rype: �Singie Family _Duptex_Townhouse _h1Wti•Family _Commercial <br /> Type o(project: _Ne�v _Addition _Remodel �Repair__T.I._Sign_Sprinkler_Demolition_Change of Use <br /> Description of Work(additicnal space prov,ded on the back)� � � <br /> IN 5cv+-t� SrN�ie 20� I��f le5s (-(�-►az� <br /> Have you started working withoul a permit? _YES �NO <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> TypcofPra�eet: _New_AJcn _Altcratlon_Repair TypoolPw�ecL• _New_AAdn _Alecrallan_Repair <br /> Show Num6or(q�n//irhnes Show Numbcr/p)olllrfures <br /> A/C—air ho.:�+iing units Toilet <br /> Poroed a��systcros Oathtub <br /> Gas pipinq Lavatory(�vash basin) <br /> Water healer Shovrer <br /> Gas fre�lacc Kilchen sink& dis osal <br /> Gastange Dishwasher <br /> Clolhes d er Ctothes washer <br /> R�mge hond Water heater <br /> Exhaust fan Sink servicelbar/mo /elc. <br /> Heat pump BackOow prevr.nter <br /> Unil heaier Urinal <br /> �oiler Drinkin Founlain <br /> Refriceratiori Floor drain <br /> N'oodslove Grease Irap <br /> Ductin Rool drains <br /> Other Aledical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM other: <br /> � Num6er ot Heads Other: <br /> 1 hereby ceiGfy Ihal I have read and examined lhis application and knowthe same l0 6e Ime and cortect.All provisions ol laws and ordinances govermr,g <br /> Ihis lype of��ork rnll be complied�hlh xhether specified herein ar noL Tho 9ranling o(a permd does not presumu to yive authority lo violate or cancel <br /> Ihe provisio of ny olher sta or lo[al lawregclaling construclion or Ihe peAormance of conslruclion,Thal I am authonzed by 1he onner af Ihis propetly <br /> lo pertorm tl e� rk for Hfii apDlicelion ly made and I comply uilh Ihe Slale Contractors law 1827 RCW and 296200 VIAC <br /> / <br /> U/,J <br /> OwnedAut orizedAgentSigna(urc Date (Fevised7J201f) <br />