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( <br /> PERMIT APPLICATION <br /> BUILDINGIMECHANICALIPLUMBINGISIGNISPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES � i0�l3--I/ <br /> 3200 Cedar St., Everett, WA 98201 -425-257-8810—FAX 425-257-8857—www.evereriwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM I <br /> SITE ADDRESS: PROPERN TA%N PERMIT f <br /> v # <br /> LEGAL far new cons�ruction: ShaA PlaVsubdivislon Lol No._ (allach copy ol long legal desuip�ion) <br /> OWNER ' � r�� Phone/E•mail <br /> Address CitylSlale2lp <br /> CONTRACTOR J. I�.� U i�i L&1 Lic.# Q p 1/ D <br /> Address Z,Z r r � , ��c�� % PhonelEmail <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Phone/E-mail <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK� 1'��c� �v <br /> Existing Use of Building <br /> HEAT SOURCE: <br /> Proposed Use of Building Ges Electric Other <br /> Building lype: ,_Single Famiiy _Dupiex_Townhouse _Mulli-Family _Commercial <br /> Type of project: _New _Addition _Remodel _Repair_T.I._Sign_Sprinkler_Demolition_Change of Use <br /> Description of Work(additional space pmvided on the bacp: <br /> Have you ataRed working without a permit7 _YES _NO <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _,New_Addn _Alterotion_Repelr Type ol Projaet� Show Nu�(M)o/llxtumstion_Repalr <br /> Show Number(M)o/Cxtures <br /> A/C—air handlin units Toilet <br /> � Forcedairs stems Bathlub <br /> Gas ipin Lavato (wash basin) <br /> Water heater Shower <br /> Gas firepiace Kitchen sink 6 dis osal <br /> Gasrange Dishwasher <br /> Clolhes d er Ciothes washer <br /> Ran e hood Water heater <br /> Exhaust fan Sink(service/bar/mopletc.) <br /> Heat pump Backflow preventer <br /> Unit heater Urinal <br /> Boiler Drinkin Fountain <br /> Refrigeration Floor drain <br /> Woodstove Grease trap <br /> Ducting Roof dreins <br /> Olher Mediwl Gas <br /> SPRINKLER / SUPPRESSION SYSTEM Other: <br /> Number of Heads Other: <br /> I hereby certity Ihal I have read and examined lhis applicalion and know the same lo De lrue and cortect.All provisions of laws end ordinances goveming <br /> ihis lype ol work will 6e complied with whetner specified herein or not.The granting ot e pemiit does nol p�esume to give aulhorily�a vlolate or wncel <br /> Ihe provision of any other sta�e or local law regulaling conslruclion or Ihe peAormance ol construction.The�I am authorized uy�he ovmer ol ihis property <br /> to peAarm�he work lor which application is made and I comply wilh Ihe Slale Contractore Law 18.27 RCW and 296.200 WAC <br /> ,l�k�f � ��"l2 � // <br /> OwnerlAuthorizad Agent Signeture Date (Revised?/2071) <br />