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PERMIT APPLICATION <br /> BUILDINGIMECHANICALIPLUMBINGISIGN/SPRINKLER/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 <br /> PROPERNTA%N MIT N <br /> SITEADDRESS: C���I Ual.�, � OU� �7 �'{b (� OU ����p2' <br /> K. <br /> LEGAL for new wnslruclion: Short PlaVsubCivislon _Lot No._ (ettach copy ol long legal desuiption) <br /> OWNER ,)2fC1^1 S�C,h� PhonelE•mail Y,- 7� ' bl <br /> ddress 31LS �-�o� � -�./ CirylStalelZip S�n\.ro- �+/ y Z L <br /> CONTRACTOR O�( L&I Lic.# <br /> PhonelEmail <br /> ddress <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> P�oneJE•mail �1�'�� U 7�� u <br /> BUILDING PERMIT APPLICATION coNTrinC7 PRICEOF WORK <br /> 4 HEAT SOURCE: <br /> Existing Use of Building�L�il <br /> Gas Elxtric Ot�er <br /> Proposed Use of Building �e.i �c - �p — <br /> 8ui�ding type: �Singie Family _Dupiex_Townhouse _Multi•Family _Commerciel <br /> Type ot project: _New _Addition _Remodel �,Repalr_T.I._Sign_Sprinkler_Demolition_Change of Use <br /> Description of Work(atltlitional space provldetl on the back): <br /> Have you started working without a permit4 _YES _NO <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> T e of Pro ect: New_Nddn __Altaratlon Rapair <br /> TypeolProJecl: _New_Adtln _Alleratlon_Repalr YP � �wNumber(N)olflrtures <br /> ShowNum6er(al olllrfures � Toilet <br /> A/C-airhandlin units Balhlub <br /> Forced air s stems <br /> � Gas i in Lavalo wash basin <br /> � Water heater Shower <br /> � Gas hreplace Kitchen sink&dis osal <br /> Gas ran a <br /> Dishwasher <br /> Cbthes d er Cbthes washer <br /> Ran e hood Waler heater <br /> Exhauslfan Sink servicelbarlmo /elc. <br /> Heal um 8ackflow reventer <br /> Unil healer Urinal <br /> Boiler Drinkin Founlain <br /> Floar drain <br /> Refri eration Greasetra <br /> Woodstove Roof drains <br /> � Ductin Medical Gas <br /> � Other <br /> SPRINKLER I SUPPRESSION SYSTEM other: <br /> Number of Heads Other: <br /> I hereby certiry Ihat I have read and examined Ihis app�����on and know lha same lo Ee irue and correct.All provisions of laws antl ortlinances goveming <br /> Ihis type ol work will be wmplied vrilh wheth^r specified hereln or not.Tlie granUng ol a permit does not Dresume to give authonty lo violata or wncel <br /> the provision ol any other slale or local law regulaling consirudlon or Ihe peAormance ol construd�on.Thal I am au�horizeC by the owner ol this pmperty <br /> to pedorm the work lor which applice�ion is made and I comply wilh lha Stale Coniractore Lew 78.27 RCW antl 298.200 WAC <br /> � .21�,��{. "�� �_ �� I � (Revised?/20f il <br /> Owner/AuJhorized�A9enl Signaluro Dale , <br />