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PERMIT APPLICATION <br /> BUILDINGIMECHANICAL/PLUMBING/SIGN/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 /> SITEADDRESS: PROPERiYTA%N PE IT � <br /> yO(� Oc-m .�c r fL � <br /> LEGALtor newcon:truction: Shoh PlaVsubdivislon Lot No._ (attach copy of long legal descnption) <br /> OWNER ��1 � ����� ���1 Phone�E�mail � 2 S' — 33a <br /> ddress ('� Q(./1J G �J F Ciry/Slale/Zip ��� � <br /> CONTRACTOR �I I` .�Cl/LCC,= L 8 1 Lic.# 1N�� �f L <br /> Address 3 j �Gr /V PhonelEmail yZS�S��O� � dO <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT/.'�� �- K��lilt�C <br /> Lo <br /> PhoneJE•mail r - s �� - `r3 fr <br /> BUILDING �PERMIT APPLICATION coNTw+CT PRICE oF WORK /�� �<� <br /> Existing Use of 3uitding HEAT SOURCE: <br /> Proposed Use oi Building Gas_ Electnc_ Other_ <br /> Buiiding type: _Single Family _Duplex_Townhouse _Multi-Family _Commercial <br /> Type of project: _New _Addition _Remodel _Repair_T.I._Sign_SprinAler_Demolition_Change of Use <br /> Description of Wo�k(adEitional space providetl on!he back/: <br /> ,�ELvc�rTz c.� p-rGrR � /�c Tc-'/� <br /> Have you started working wilhout a permil7 _YES �NO <br /> h7ECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Typoo(ProJect: _New_Addn _Alterallon_Repair TypeolProJecl: _New_Addn _Alterotion_Repalr <br /> Show Number flq of lirturcs Sliow Num6er(MJ o/flxlures <br /> AIC–air handling units Toilet <br /> � Forced air syslems Bathtub <br /> i Gas pipin Lavato wash basin <br /> � Waler healer � Shower <br /> � Gas fireplace Kitchen sink 8 dis osal <br /> Gas ran e Dishwasher <br /> Clolhes dryer I Clothes washer <br /> Ran e hood Water heater <br /> Exhaust fan I Sink(servicelbar/mo /etc.) <br /> Heat ump � BackOow reventer <br /> Unit hcater � Udnal <br /> Boiler Drinkin Founlain <br /> Re(rigeration Floor drain <br /> � Woodslove I Grease Ira <br /> Ductin I Rootdrains <br /> Olher Medical Gas <br /> SPRINKLER/SUPPRESSION SYSTEM I O�her: <br /> INumber ol lieads I Olher: <br /> I hemby certity that I have reaa and examined Ihis application and hnow t�e same to be(rue and wrrecl.All pmvisions of laws and ordinances goveming <br /> lhis type of woik xill be wmplied x�lh whether specdied herein or noL The granting of a permit does no�presume to give authonty�o violale or w�c^I <br /> the provision ol any oNer slalo or local Iawreguiating wnslruclWn or Ihe pedormance ol construction.That I am authonzed hy tho axner of this pmperry <br /> to peA��wo�k for xhich applicatiofi�s made and I co9�piy wrth ihe Stala Contreclors Law 1827 RCW and 298.200 WAC <br /> / /' � <br /> i <br /> -� t�t– �� D,i - ---�r-' _S� – <br /> �OwnedAutl� zedAgentSignatura� Dale (Revi5ed�017) <br />