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� '. <br /> PERMIT APPLICATION <br /> BUILDINGIMECHANICAUPLUMBING/SIGNISPRINKLERIDEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 -425-257-8810—FAX�25-257-8857—www.everettcwa.org ✓,I <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM c� "o� <br /> SITEADDRESS: PROPERTVTA7(p PERMITtt _ ^ <br /> E � � � e d <br /> LEGAL lor new conslruction: Shoh PlaVsubdivision Lol No._ (attech wpy ot lonp legal desc�ip�ion) <br /> OWNER 1 � Phone(E-mail �y.0 �' �I �� <br /> Address <br /> 5 (�- �vQ 5i� CitylStelelZlp � <br /> CONTRACTOR V \��t L&I Lic.# <br /> Address PhonelEmail <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT . , <br /> Phono/E•mail <br /> BUILDING PERMIT APPLICATION CONTRACT aRICe oF WORK <br /> Existing Use of Building � HEAT SOURCE: <br /> Proposed Use of Building — Ges,_ Eledr�c Other <br /> Building lype: _Single Family _Duplex_Townhouse _Multi-Family _Commercial <br /> Type of projecl: _New _Addition _Remodel _Repair_T.I._Sign_Sprinkler_Demolition_Change at Use <br /> Desc�iption of Wo�k(additional space provided on fhe beck): / ` / ` / /�_ <br /> •—T' 3�_, y p' vl� �"^n a '–`. J� J�`,--+�/�S 5 !.�-���f..c /Lo.e.�-�e-'L– <br /> �_r� y�,��,� Q <br /> Have you sWrted working without a pertnit? _YES _NO <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type ot ProJact: _New_Addn _Alteration_Repslr Type of Pro�ett: _New_Addn _Akentlon_Rapdr <br /> Show Numbar(N)o/Rrtures Show Number(M)oI flxtuns <br /> AIC–airhandlin units Toilet <br /> Forced air s stems Bathtub <br /> Gas i in Lavato wash basin <br /> Water heater Shower <br /> Gas fire lace Kitchen sink&dis asal <br /> Gas ran e Dishwasher <br /> Clothes d er Clothes washer <br /> Ran e hood Water heater <br /> Exhaust fan � Sink(service/bar/mo letc.) <br /> Heat um 6ackflow reventer <br /> Unit heater Urinal <br /> Boiler Drinkin Fountain <br /> Reiri eration Floordrain <br /> Woodsrove Grease tra <br /> Ductin Roof drains <br /> Other Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM other: <br /> Number of Heads Other: <br /> I hereby certiy thal I hava read and examined thls applicatlon and know Ihe same to be Inie and correct.Ail pravisions of laws and orclinances goveming <br /> this�ypo 01 work will be complied with whelner specified herein or not.The granting ol a permit does not presume lo give authority to violata or cancel <br /> lhe provislon of eny other stale or local law regulating consiruction or the peAormance oi conslruction.Thel I em authorize�f by Ihe owner of ihis property <br /> la pertom Ih ,worlc�lor w�ch app�n is made e� nd I comPlY wilh ihe Slete Coniradore law 18.27 RCW and 298.200 WAC <br /> � ��� Jlr7S7/�/ <br /> Ownerl4ut odzed Agent Slgnature � �—� Dale (Revised 7/2077) <br />