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( <br /> PERMIT APPLICATION <br /> BUILDING/MECHANICALIPLUMBING/SIGNISPRINKLER/DEMOLITION <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 a/ �0�'`�� <br /> SITE ADDRESS: �21 _ ���C,� � n PROPERTY TA%N P�RM T�/O _ <br /> Q\ <br /> LEGAL far new conslruction: Short PlaUsu6division Lot No._ (altach copy o�lang legal description) <br /> OWNER � (,31 � S�� <br /> PhonelE-mail �[.�4 '�I � � ` <br /> Address <br /> ? 7 „ � � , CitylS�ate2ip 8��' �3 <br /> CONTRACTOR L 8 I Lic.M <br /> Address PhonelEmail <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> PhonefE-mail OW�(J <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK D o o �— <br /> Existing Use of Buiiding HEAT SOURCE: <br /> Propased Use of Buiiding Gas Eleclric_ Other_ <br /> Building type: Singie Family _Duplex_Townhouse _Mulli-Family _Commercial <br /> Type ot projec�New _Addilion _Remodei _Repair_T.I._Sign_Sprinkler_Demolition_Change of Use <br /> Description of Work(addifional space provided on the back): � ,S� <br /> C,�// — O <br /> � <br /> Have you started working wilhout a permit7 _YES _NO � E N� 'J(��"f 1 O IJ �, p al f <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> TypeofProJret: _New_Addn _Alteration_Ropalr TypeofProJacl: _New_Addn _Aftention_Rapalr <br /> Show Number(M)o//ixtures Show NumDer(N)of/lxturos <br /> A/C—air handlin units Toilet <br /> Forced air s stems Bathtub <br /> Gas ipin Lavato (wash basin) <br /> Water heater �hower <br /> Gas lreplace Kitchen sink&dis osal <br /> Gas ran e Dishwasher <br /> Clolhes d er Clothes washer <br /> Ran e hood Water heater <br /> Exhaust fan Sink(servicelbar/mop/etc.) <br /> Heat pum Backflow preventer <br /> Unit heater Urinal <br /> Boiler Drinkin Fountain <br /> Refri eration Floor drain <br /> � Woodstove Grease tre <br /> Ducting Roof drains <br /> � Other Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM Other: <br /> Number of Heads Other: <br /> I hereby cenity thal I have read and ezamined thts applicalion and know lhe same lo be Irue and corted.All provisions of laws and ordinances goveming <br /> this lype ol work will be camplied wilh whether specifietl herein or nol.The granling of e permit dces not prasume to give authority lo violate or eancel <br /> Ihe provision of any olner slalo or local taw regulating conslruction or the peAormance ol conslruclion.Thet I am authorized by the owner of this property <br /> to perform the work lor which application is made and I comply�rrith Ihe Slate Conlractors Law 1�27 RCW and 298200 WAC <br /> (��1t'h;,. �,.1.y� i��'l/S�l� <br /> OwnerlAu orizod Agant Sl�naturo � (Ravised 7/2017) <br />