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( <br /> PERMIT APPLICATION <br /> BUILDINGIMECHANICAUPLUMBINGISIGN/SPRINKLERIDEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett,WA 98201 -425-257-8810—FAX 425-257-8857—vwvw.everettwa.or <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM S �'� q" � I <br /> SITEADDRiSS: V PROPERTYTAXp PERMITi _�� <br /> LEGAL for new conslruction: Short PlaVsubdivision Lol No._, (allach copy of long legal desuiplion) <br /> OWNER �I�n J (( PhonelE-meil �rz.S � ' <br /> Address 6a S / ciryis�aiarz�P —✓UP�' l� ` D <br /> CONTRACTOR L/�N12 L&I Lic.# <br /> Address Phone/Email <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Phone/E-mail <br /> BUILDING PERMIT APPLICATION CONTRAcr PRlce oF WORK <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building Gas_ Electric otAer <br /> Buildingtype: _SingleFamily _Duplex_Townhouse _Mulli-Femily _Commercial <br /> Type of project: _New Addition _Remodel _Repair_T.I._Sign_Sprinkler_Demolition_Change of Use <br /> Description of Work(additional space provided on the back): �� /�� / �� I� / �, /_�1�� <br /> �� / l i���' �� <br /> Have you sWrted working without a pertnit7 _YES _NO ' <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type ol ProJect: New_Addn _Altention_Repalr 7ype ol ProJeel: New_Addn _AHsntlon_Rapalr <br /> Show Number(M)ot Rxtures Show Number(M)01/Ixfuns <br /> A/C—air handlin units Toilet <br /> Forced air s stems BatMub <br /> Gas i in Lavalo wash basin <br /> Water heater Shower <br /> Gas fire Iace Kitchen sink 8 dis asal <br /> Gasran e Dishwasher <br /> Clothesd er Clolheswasher <br /> Ran e hood Water heater <br /> Exhaust fan � Sink(servicelbar/mo /etc.) <br /> Heat pump BackFlow prevenler <br /> Unit heater Urinal <br /> Boiler Drinkin Fountain <br /> Refri erelion Floordrain <br /> Woodslove Grease tra <br /> Ductin Roof drains <br /> Olher Medical Gas <br /> SPRINKLER/SUPPRESSION SYSTEM Other: <br /> Number ot Heads Other: <br /> I hereby certity that 1 have read and examined Ihis epplication and know the sama to be true and cortect.All provisions oi laws e�d ordinences qoveming <br /> Ihis lype ol work will 6e complied with whether spedfied herein or not.The grenting of a permil does nol presume to give authoriry to Wolate ur cencel <br /> the provision of any other state or Iocal law regulaling consirucllon or the peAormance ot consiruction.That I am authorized by Ihe ovmer ol this property <br /> to pertorm Ihe ork for which appliwllo made and I comply with Ihe Slat Conlraqors Law 18.27 RCW and 298.200 WAC <br /> ��^� 5 8' /l <br /> OwnerlAulhorized Agant Slgnalure Da�e (Revised?/2017) <br />