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( <br /> �PERMIT APPLICATION <br /> BUILDINGIMECHANICAUPLUMBING/SIGNISPRINKLERIDEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Evereri,W A 98201 -425-257-8810—FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 0 AM TO 4 PM <br /> s��"°°RESs: 13zS PAaii� �4ve vn v�arr Oz / P RMITt <br /> LEGAL 1or new cor�strudian: Short PlaVsubdivision Lot No._ (ettach copy of long legal descnption) <br /> OWNER Phone/E•mail <br /> Address City/StatelZip (,� <br /> CONTRACTOR L&I Lic.ft � �� <br /> ddress �S � PhonelEmail Z <br /> ����� PhonelE•mail �c �f� � <br /> dU1LDING PERMIT APPLICATION ONTRACT PRICE OF WORK <br /> Ezisting Use of Building HEAT SOURCE: <br /> Proposed Use of Building Gas E�eanc Other <br /> Building type: _Single Family _Duplex_Toxmhouse _Muiti-Family J�,Commercial <br /> Type oi project: _New _Addition _Remodel _Repair�T.I._Sign_Sprinkler_Demdition_Change of Use <br /> DesCription Ofy� (adddronal space provided on fhe back): <br /> I�ar.tw l3�s/ur sqstr.w� M�•�r/+�n•�s R,w �i�IM�Rs �Ms��rca �rv.r �,�,o <br /> �FI�M.�A..l�li��/ 4�v�E3. <br /> Have you stert�d workinp without a parmkT _YES NO <br /> MECNANICAL PERMIT APPLICATION PLUMSINO PERMIT APPLICATION <br /> Typs of ProJed: _Naw_Addn _Alteralion_R�palr Type of Prqact: _Naw_Addn _AR�ntlon_RpNr <br /> Show NumMr t d Ilrfuns SAow NumMr d IOrtuns <br /> AIC—airhandlin units Tp�� <br /> Foiced air s stems BatMub <br /> Gas i in Lavat wash basin <br /> Water heater Sh°wer <br /> Gas fire lace Kitchen sink 8 dis osal <br /> Gas ran Dishwasher <br /> Clothes d er Golhes washer <br /> Ran e hood Water heater <br /> Exhaust fan Sink servicelbar/m letc. <br /> Heat um 8ackflow reveMer <br /> Unil heater Urinal <br /> Bdler Drinki Fountain <br /> Refri eration Floor drain <br /> Woodsrove Grease tra <br /> Ductin Roof drains <br /> Olher Medical�as <br /> EPRINKLER / SUPPREss10N s1fsTEM aher: <br /> � Number oi Heads Other: <br /> I hereby cetlily Ihat I have read and examined Ihis appliwlion and know Ihe same la be true and cortecl.A�I provisions ol laws and oMinances goveming <br /> Ihis type of vrork will be complied with whelher specified herein or nol.The granting of a permA does not presume to give aNhority lo violale or cancel <br /> the provision of any olher state or local I w regulaling construction or the peAortnance of consiructian.Thal I am authonzed by the11ovmer ol lhis property <br /> peAorm the v. tor which a plicalion i ade and I comply wilh Ihe State Contrectors Law 1827 RCW and 296.200 WAC p I�� <br /> I <br /> r �z <br /> OwnerlA or:e �Ign ure Date �Revised7/201fJ <br /> ��2 <br />