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( <br /> PERMIT APPLICATION <br /> BUILDINGIMECHANICAUPLUMBlNGISIGNISPRINKLERIDEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 96201 -425-257-8810—f AX 425-257-8857—www.everethva.org '� <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TC 4 PM �-��� <br /> SITE ADDRESS: PROPENTV TAIf p P RMIT R _oo� <br /> LEGAL lor�ew conslruction: ShoA?IaUsuhdivision _Lot No._ (altach wpy ol IonB legal Cescriptionl <br /> OWNER� � � PhonelF-mail 3 U' <br /> Address �0 �;� o.- CilylSlatelZip p �o. <br /> CONTRACTOR L&I Lic.# <br /> Address Phone/Email <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> PhenelE•mail <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of Building 5 �� o�. HEAT SOURCE: <br /> Proposed Use of 8uilding Gas_ Electnc_ Other <br /> Building type: _Single Family _Dup`ie/z_Townhouse _Multi-Family ,_Commercial <br /> Type of project: _New _Addition �Remodei _Repair_T.I._Sign_Sprinkler_Demolition_Change of Use <br /> DeScripti0n of Work(additional space provided on fhe 6ack/: ��^'O f� I� � <br /> �� Ul .'�-D y1�l�� <br /> P"�`' <br /> PurcV�a-� <br /> Have you atarted working without a permit7 _YES _NO <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of ProJect: _Naw_Addn LAlteratlon_Repair Type ol ProJect: _New_Add��Altsntlon_Rep�ir <br /> Show Num6er(N)o//ixtures Show Numbar(N)o/flxtures <br /> A/C-air handlin units Toilet <br /> Forced air s stems Bathtub <br /> Gas ipin 1 Lavato (wash basin) <br /> Waler healer Shower <br /> Gas fire lace Kitchen sink&dis osal <br /> Gas ran e Dishwasher <br /> Clothes d er Ciothes washer <br /> Ran e hood Water heater <br /> Exhausl fan Sink(sen'ice/bar/mop/etc.) <br /> Heat pump � Backtlow preventer <br /> Unit heater Urinal <br /> Boiler Drinkin Fountain <br /> Refri eration Floor drain <br /> �, � �, �.{ Grease tre <br /> Ducting Roof drains <br /> Other Medical Gas <br /> SPRINKLER I SUPPRESSION SYSTEM other: <br /> Number of Heads Other: <br /> I hereby ceMity Ihat I have read and ezamined ihis application and know Ihe same lo be true and corted.All provisions ol laws and ordinences goveming <br /> �his type o1 work will 6e complied with whether specifetl hercin oi nol.The grenting of a permi�tloes not presume to give authority to violate or cancel <br /> the pm�jsioq ol any other state or lopal law regw ating construclion or Ihe pedormance of con=truction.Thet i am authorized 6y the owner ol ihis property <br /> to peflorm Ne w lo�ch ap ation is made and I comply wilh the State Contractors Law 18.27 RCW and 296.200 WAC <br /> 1 . � � �— <br /> ' wnerlAuthorizedAgen Signature Date (Revise0Y101f) <br />