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( <br /> PERMIT APPLICATION <br /> BUILDINGIMECHANICALIPLUMBING/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 �-'aS' I I <br /> SITE ADDRESS: U�M �r PROPERTV TA%N P RM �L a ' Ol(� <br /> j L�J �� <br /> LEGAL for new conslruction: Short PlaVsubdivision Lot No._ (atlach copy o1 long Iegal descriplion) <br /> OWNER p� i S � ( 0� 'n PhonelE�mail /�C(7� rPnTf<:.. D�D I/ .�C <br /> Address a.(�� CilylSlatelZip � � / �� <br /> � L&ILIc.# <br /> CONTRACTOR ' v+�r�L./ <br /> Address PhonelEmail <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT `�;�,� <br /> PhonelE•mail .�L �-� �7 G` <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use o(Building �� � / �/ HEAT SOURCE: <br /> Proposed Use of Building�(l�U C f f 1 OA d t SQ�OCI � � ��L�4q'�` Gas x Eleclric_ Olher_ <br /> � Commerciel <br /> Building type: �C Single Family _Duplex_Townhouse _Multi•Fam y ,_ <br /> Type of projecl: _New _Addition ,ZC Remodei ,_Repair_T.I._Sign_Sprinkler_Demolition_Change of Use <br /> Descnption of Wo�k(addilionai space provided on fhe back�: 'L / �/ � � <br /> SCC'. Q�/OCI�fA' SCr�� ��^-+ <br /> � J <br /> ��h.�.�J�"� ll ,� {i.u.1r�..� Ci�J„t f j��t :L �3G�c IS <br /> Have you started working without a pertnit7 �YES `_NO`' <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Typo ol PrcJoct: _New X Addn _Alteratlon_Repair Type oi ProJact: _New�Addn _Altentlon_Rapair <br /> 9how Number(MJ olllxfures Show Number(N)ol flxtures <br /> A/C—air handlin units Toilel <br /> Forced air s stems Bathtub <br /> � � Gas pi ing Lavato (wash basin) <br /> Water heater •< Shower <br /> Gas fireplace Kitchen sink&disposal <br /> Gas range Dishwasher <br /> � Clothes d er 1 Clothes washer <br /> Ran e hood Water heater <br /> j, Exhaust fan / Sink(service/barlmop/elc.) <br /> Heat pump I BackAow preventer <br /> Unit heater Urinal <br /> Boiler Drinkin Fountain <br /> Refrigeretion Floor drain <br /> Woodstove Grease lrap <br /> �, Ducling Roof drains <br /> Other Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM other: <br /> Num6er of Heads Other: <br /> I hereby ceAify Ihat I have read and examined Ihis application and know Ihe same lo be Iruo and cortecl.All provisions of laws and ordinances goveming <br /> lhis type of work will be complied wilh whelher specified herein or not.Tho granting of a permit does not presume lo give aulhorily lo violalo or wncel � <br /> Ihe provision of any oihur stale or local law regulating consWclicn ar Ihe peAormance ol construction.Tha�I am authorized hy lhe owner of this pwpeAy � <br /> to pertorm the work for which.application is made and 1 comply wi�h the Slale Conlrac�ors Law 18.27 RCW and 296.200 WAC I p <br /> �'�� G � • <br /> r'`•�" ::�';.� "-_ <br /> Ownor/Authorizad Agont Signalure Da�e (Revised 2R0f 1) <br />