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� <br /> PERMIT APPLICATION <br /> BUILDINGIMECHANICAL/PLUMBINGISIGNISPRINKLERIDEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <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 /> PROPEHTYTAIf N PERMIT N <br /> SITE ADDRESS: I/ �J'�OQZ <br /> r \ <br /> LEGAL for new wnsiruction: S�ort PlaUsubdivislon _Lot No._ (eltach copy of long legal descriptlon) <br /> PhonelEmaii /t� • f ' � S� • C � <br /> OWNER �/ � <br /> ddress � � C lh i CirylStale2ip � �(� �� <br /> CONTRACTOR � �' Y L&I Lic.# <br /> P�oneJEmail � �^ � � d� � <br /> ddress <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> PhonelE•mail <br /> BUILDING PERMIT APPLICATION <br /> CONTRACT PRICE OF WORK • � <br /> HEAT SOURCE: <br /> Exisling Use ot Building <br /> Gas Eleciric,_ Other_ <br /> Proposed Use o�f B�uilding_ <br /> Building typa: 1Lsingte Family _Duptex_Townhousa _.Multi-Family ,_Commercial <br /> Type ot projecl: _New _Addition _Remodei _Repair_T.I._Sign_Sprinkter__ Demolition_Change ot Use <br /> DesuipUon of Work(adtlifianal spare provided on the back): �� �.� �'p R �f� .I-U f C�,\ � Q. S <br /> Have you started working without a permit7 _YES _NO <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of ProJecl: _New_Addn _Alterallon_Repalr Type ol Projeet: Sno BNumDardfp o!flxfu`resUon_Repair <br /> Show NumDer(N)ol Rxfures Toilet <br /> � AIC-airhandlin unils Bathtub <br /> � Forced air s stems Lavato wash basin) <br /> Gas iin Shower <br /> � Water heater Kitchen sink&dis osal <br /> � Gas fire lace Dishwasher <br /> Gasran u Cbtheswasher <br /> Clathes d er Water heater <br /> Ran e hood <br /> Exhauslfan Sink servicelbar/mo letc.) <br /> BackFlow reventer <br /> Heat ump Urinal <br /> Unit healer <br /> Orinkin Founlain <br /> Boiler Floor drain <br /> Refri eralion Grease�ra <br /> � Woodslove <br /> Roof drains <br /> � Ductin Medical Gas <br /> � Olher <br /> SPRINKLER I SUPPRESSION SYSTEM other: <br /> Number ot Heads Other: <br /> I hereDy certiy that I have read antl examined this appliwlion end know iha same lo be irue antl correc4 All provisions of laws and ordinances goveming <br /> Inis rype ol work vnll be wmpiied wilh whMher specifed herein or not.The granUng ol a permit dces not presume to give aulhonty to violate or wncel <br /> t�e pwvisian ol any other stale or local law re9ulaling conslmclion or lhe peAormance ot conSWction.Thal I am aulhodzed 6y tAe owne�ollhis propery <br /> to peAorm the work lor which appli alion is made and I compy w h ihe State Conlraclats Law 78.27 RCW and 298.200 WAC <br /> ��.,,�,� `��.�_,____ 31a��o�a ,Ra�,S��o,,, <br /> OwnerlAuthorized Agent Signalura Date <br />