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PERMIT AWPLICATION <br /> BUILDINGIMECHANICALIPI_UMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY C� 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 7�- /Z �— <br /> SITE ADDRESS: PHOPERiV TA%p PERMI7 R <br /> —00 Z <br /> LEGAL br new conslruction: Shorl PlaVsubdivision La�No_ (aUach copy al long legal tlescriplion) <br /> OWNER PhonelE-mail <br /> Address Q (S f"Y1.C'MJt!?e. �� �jp�,�� City/5tatelZi� <br /> CONTRACTOR T � L 31 Lic.# TIL EDCtJG S <br /> Aduress � � �0 I l 9gZ 13 PhonelEmall <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> PhonelE�mail <br /> BUILDING PERMIT APPLICATION CONTRF.CT PRICE OF WORK <br /> Existing Use o(Bwlding �o��O�nco_ HEAT SOURCE, <br /> Proposed Use of Building Gas Gectric Olner <br /> Building type: �Single Family _Duplex_Townhouse _Multi-Family _Commercial <br /> Type of project: _New _Addition _Remodel _Repair_T.I._Sign_Sprinkler_Demolition_Change of Use <br />� Descripti0n o�Work(adddional space provided on the DackJ: <br /> Have you started working without a permit? _YES _NO <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> TypaotPro�ect: _New_Addn _Alteratian_Repair TypeofProJecl: _Now_Addn _Alleratlon_Repair <br /> Show NumDer(N)o//ixtures Show Numbcr(p o!/ixfurns <br /> A/C-air handling units Toilet <br /> Forced air syslems Balhlub <br /> Gas piping Lavatory(wash basin) <br /> Waler heater Shower <br /> Gas fireplace Kitchen sink 8 disposal <br /> Gas range X Dishwasher <br /> Clothes d er Clothes washer <br /> Rangehood )c Waterheater <br /> Exhaust fan Sink(:ervicelbadmopletc.) <br /> Heat pump �ackflow preventer <br /> Unil hea�er Urinal <br /> Boiler Drinking Fountain <br /> Refrigeration Floor drain <br /> Woodstove Grease trap <br /> Ducling Roof drains <br /> Other_ Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM Other: <br /> Number of Heads Other: <br /> I hereby certify ihat I have read and ezamined Ihis applicalien and know Ihe same lo he We and coRect.All provisions of laws and or0inance5 goveming <br /> this lype ol work vrill 6e complied with whether specifetl herein or noL The granling of a permit does nol presume lo give aulhorily lo violate or cancel <br /> the provision ol any other state or;oca!law regulating construclion or Ihe pedormance ol construclioa That I am authonzed by Ihe owner of this property <br /> �a ertorm he work lor which applicalion i,made and t comply wilh Ihe Stale CoNractors law 18.27 RCW and 296.200 WAC <br /> wnerlA� honz d' gont ignatum Dale (Revised 7/2011J <br />