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1 � <br /> j _ <br /> PERMIT APPLICATION <br /> BUILDINGIMECHANICAUPLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 -425-257-8810—FAX 425-257-8857—vwvw.evereriwa.org <br /> APPLICATIONS ARE ACCEPTED FROM a AM TO 4 PM �I �- �` I I <br /> SITE ADDRESS: PROVERTY TA%M �. Pfyg�1T N I <br /> . ^ 7 !YI <br /> LEGAL for new shuction: Short PlaVsubtlivisi Lot Nq� � (attadi capy of bng kgal description) <br /> OWNER PMnrlE-mail � <br /> Ru City/State/Lp ' /� <br /> CONTRACTOR � � L 8 I Lic.S L � <br /> ��5 ' � � �-� phonelEmail �S�S <br /> TENANT USINESS NAME CONTACT FOR PERMIT �Q rV <br /> P <br /> Phone/E-mail � —'� 7.5-- /,� <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK ��'iYJ . — <br /> Existing Use oi Building HEAT SOURCE: <br /> Proposed Use of Buiklirg Gas Eiectric Other <br /> Bui�ding type: �Single Family _Duplex_Townhouse _Multi-Family _Commercial <br /> Type of project: _New _Addition _Remodel �Repair_T.I._Sign_Sprinkler_Demolitlon_Change ot Use <br /> Description of Work(addRionai space p�ro�v�ided on the bedc): <br /> �2�l�.'?/CF L:G�/�2 O� <br /> t� v <br /> Have you ffarbd working without a permit7 _YES �NO <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Typa of Projact: _New_AdCn _Alteration_Repsir Typa of Project: _Naw_Addn _Albrotlon_Rapair <br /> Show Number(Aq o!flrtures Show Number )ol flxtures <br /> i A!C-air handlin units I Toilel <br /> Forced air s stems Bathtub <br /> I Gas i in � Lavato wash basin <br /> Water heater Shower <br /> I Gas fire lace Kitchen sink 8 dis osal <br /> ; Gas ran e i Dishwasher <br /> Clothes d er Clothes washer <br /> I Ran e hood I Waler heater <br /> Exhaust fan I Sink service/bar�mo /etc. <br /> Heat um Back9ow reventer <br /> I Unit healer I Urinal <br /> '� Boiler � Drinki Fountain <br /> i Refri eration I Floor drain <br /> Woodstove I Grease tra <br /> Ductin Rooi drains <br /> Other i Medical Gas <br /> SPRINKLER I SUPPRESSION SYSTEM � Other. <br /> Number of Heads aher: <br /> I hereGy certily that 1 have read and ezamined this application aM kno�v the same to be We anC correcl.All provisions of laws an0 ordinances goveming <br /> this type of worVc will be complied with w�Mher specified herein or not.The granting of a pertnit does not p�esume to give authorily to vidate or carkel <br /> the provisbn of any other state or lo w regulating construction a the per!omiancn ol consiruction.Thal I am aultarized by the oMne�of this properry <br /> to peAortn t work br which pli tion s made aM 1 camply wiM the State ContiaUUors Law 78.27 RCW and 296.200 WAC <br /> , ��' + 2 - - / <br /> e Authorized Agant Signature Dare (Revised Y2011J <br />