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( <br /> PERMIT APPLICATION <br /> BUILDINGIMECHANICAUPLUMBINGISIGNISPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 -425-257-8810—FAX 425-257-8857—vwvw.everetlwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM ?j —�{�- �� <br /> SITEA�DSOS r 1 V L J�'�` i-�T ��ct�'C�{' PROPERTYTA%M PERMIIO3- v <br /> LEGAL(or new consiruction: Short PlaVsubdivision Lot No._ (ettach wpy of long legal descrtplion) <br /> OWNER �0.So.� 1�ST�p1�„�,; � Pc���a,��� � Phone/E-meil <br /> � 50 S �j v� ` Ci /StetelZip u1 01'� ^ <br /> Address ry t�v' rr <br /> CONTRACTOR tQ �.,w0.7s ��� � L81Lic.# IT � w'� �� Y 5� '3 �/_ <br /> nddressQD,QuX �35� S�clfav. ,�« . 9�a9 `-� phonereman� l'��. 5.1b«���a►+oo•�° '''� <br /> TENANT BUSINESS NAME CONTAC7 FOR PERMIT <br /> Phone/E•mail <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use ot Building �S i d � -. 7�� `� � HEAT SOURCE: <br /> Proposed Use ot Building Ges Eledn Other <br /> Building type: x Single Family _Duplex_Townhouse _Multi-Family _Commercial <br /> Type oi projed: _New _Addilion X Remodel _Repair_T.I._Sign_Sprinkier_Demolition_Change of U1se <br /> Desc�iplion of Wo�lc(edditlonel spece provided on fhe beck): '�'� �„ p(a, ..,,i J R1�o 1 1 �� <br /> y:sl 7 1` 4\\ � �v � w w � ^��u -✓ ^ � /� ' 1 N �� '-c� <br /> ,� s,�y�� h�,�� �x� , Jp�R� �JL.`� k..a d � <br /> Have you atartad work�ng without a pertnit7 _YES _NO <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> TypaofProiect: _New_Aodn _Alteralion_Ropalr TypaofProJecl: _New_Addn _AlUwtlon_Repdr <br /> Show Number(MJ o!/lxtures Show Num6er(NJ o/flxfures <br /> A/C-air handlin units Toilet <br /> Forced air s stems Bathtub <br /> Gas piping Lavato (wash basin) <br /> Water heater Shower <br /> Gas fireplace Kitchen sink&disposal <br /> Gas renge Dishwasher <br /> Clothes dryer Ciothes washer <br /> Range hood Water heater <br /> Exhaust fan Sink(servicePoadmop/etc.) <br /> Heat pump BackOow revenler <br /> Unit heater Urinal <br /> Boiler Drinkin Foun�ain <br /> Refrigeration Floor drein <br /> Woodstove Grease trap <br /> Ducting Root drains <br /> Oth�- Mediral Gas <br /> SPRINKLER / SUPPRESSION SYSTEM Other: <br /> Number o(Heads Other: <br /> I hereby certify�hal I have reatl and ezamined Ihis applicalion antl know ihe same to be Irue and conecl.All provisions of laws and ordinances qoverning <br /> Ihis type ol work will be complied wilh whelher specifed herein or nol.Tho granling of a permit does nol presume lo give aut�ority�o viota�e or wncel <br /> lha provision ol any other slale or local Inw regulating conslruction or Ihe peAormance o1 conslmction.That I am authorized Dy�he owner ollhis pmperty <br /> �a rfonn�lo hic application's made and I comply with�he Stala Conlradors Law 18.27 RCW and 296200 WAC <br /> � 3-y^ 1 I <br /> Owner/Authorizod Agent SlgnaWre Date (RevisedY2017) <br />