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PERMIT APPLICATION <br /> BUILDINGIMECHANICALIPLUMBING/SIGN/SPRINKLERIDEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett,WA 98201 -425-257-8810—FAX 425-257-8857—www.evereltw/a.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM b '-'I�� Z <br /> SITEA�DRESS: O �n� � / „�� PROPERTYTA%It � �'J'/'��,I <br /> -�f[ lJ.fi V� <br /> LEGAL for new construclion: Short PlaUsubdivision _Lot No._ (altach copy of long legal tlescriplion) <br /> OWNE �/�0 1 `J��e Phone/E�mall lil'r y��-6s� / <br /> ddress �T o . LLb��� �7� S� �' CitylStatelZ�p f'{'C- K.� / �b <br /> CONTRACTOR L&I Lic.# <br /> �o E i1 <br /> Address <br /> � TENANT BUSINESS NAME� CONTACT FOR PERMIT <br /> n ,fA�� ���f <br /> F�- Phane/E�mall C 7 ' S � <br /> BUILDING PERMIT APPLICATION CONTttacT PRICE oF WORK I 5 Z� <br /> Existing Use of Building HEAT SOURC <br /> ProposedUseo{Building ��n . cas_ Eiec:ric other_ <br /> Building lype:�,,,,Single Family ,_Du`ple/z_Townhouse _Multi-Family _Commercial <br /> Type of projecl: _New _Addition ,,yC Remodel _Repair_T.I._Sign_Sprinkler_�emolition_Change of Use <br /> Desai tlon of Work additional s ace provided on fhe back): � � �„� <br /> P ( P <br /> ( o��rc� e�,,yl.�i6 P�"'� Clali'f� C-�c,-,oay iteo -l�o � c/ � �F o <br /> L��-������ Cl�k� <br /> Have you started working wilhout a permit? _YES �,NO <br /> MECHANICAL PE RMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> TypoolProject: _New,_Addn Alterallon_Repair TypoolProJect: _Ne ddn Atleratlon_Repai� <br /> Show Num6er(p)o/flrtures Show Num6er(C1 0l Rxfures <br /> � A!C-airhandlingunits � Toilet <br /> � Forced air s stems I Bathtub <br /> Gas ipin Lavalo (wash basin) <br /> � Waler heater I Shower <br /> � Gas fireplace Kitchen sink 8 disRosal <br /> Gas ren e Dishwasher <br /> Clolhesdryer I Clolheswasher <br /> Range hood � Waler heater <br /> Exhausl fan I Sink(service/bar/mop/elc.) <br /> Heat pump I Backllow preventer <br /> Unit heater I Urinal <br /> Boiler Drinkin Fountain <br /> Refrigeration I Floordrein <br /> Woodstove I Grease trap <br /> � Ductin Roof drains <br /> � Other Medical Gas <br /> SPRINKLER/ SUPPRESSION SYSTEM Other: <br /> � Num6erofHeads � Other: <br /> I hereby certity Ihat I'�aw read and ezamined Nis apptication and know tho same to be truo and corrxL All pwvisions of laws and ordinances 9oveming <br /> tnis typo ol work�nll te wmplied vnth whelher specified herein or not.The granting ot a permit does not presuma�o give authonly to violate or wncel <br /> tho Frovision of any olher stato or local law regulating wnstructlon or Ihe perlortnance ol construction.Thzl I am authonzed by Ihe owner of this properry <br /> to�orm Iho wn:K lor whi h npDlicalion Is made and I wmpy�hth Iha State Conlr�ctors Law 18.27 RCW and 298.200 WAC <br /> ,- ol- �u/L <br /> � '' (Revisedl/10If) <br /> OwnedAiChorixy gent5lgnaWro �'�a <br /> i <br />