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PERMIT APPLICATION <br /> BUILDINGIMECHANICALIPLUMBING/SIGN/SPRINKLERIDEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everetlwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �O " �—� 2 <br /> SITEADDRESS:O � PNOPER7VTA%p PERMIT# <br /> LEGAL lor new constmcticn: Short PlaVsubdivision lot No._ (attach copy ol long legal descnption) <br /> OWNER ��_ P�one/E�mail �3 1�CA7"` <br /> Address Q � City/5tate.2ip - � � <br /> APPLICANT:,�Owner Gwner'sAgent Contraztor _ConlracloYSAqeN _Tenam�m�.��ro,ae.kr�roi�o�>.�:nommewM��oao.on���me.w�o1 <br /> CONTRACTOR � C L&I Lic.# CO[Dus.Lic.# <br /> ddress Phone/Email <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Phone/E-mail <br /> BUILDING PERMIT APPLIC,4TION CONrRACT PRICE OF WORK <br /> Ezisting Use of Building HEAT SOURCE: <br /> Proposed Use of Building Gas_ Eiectnc ✓ Other <br /> Building type: i�. Single Family _Duplex__Townho/u9e _MWti-Famity _Commercial <br /> T pe of projecC _New Addition _Remodel y_Repair T.I._Sign Sprinkler Demolition Chan e of Use <br /> � �/' � <br /> DESCRIPTIONOFWORK(adtlitionalspaceprnvitletlonmebacA): RLR� y�,�37�iw1� s�rvC{iv*L• <br /> ol <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Typo of ProJect: _New_Addn _AlleraUon_Repalr Type of ProJect: _New_Addn _Alleratlon_Repalr <br /> hmc Numbc�(q)ollixfures Show Number(a)o!lGtures <br /> AIC–air hrndling units Todet <br /> Forced air s slems Bath�ub <br /> \ Gas piping Lavslo (wash basin) <br /> `. Water heater � Shower <br /> Gas�replace Kitchen sink&disposal <br /> Gas range I Dishwasher <br /> Clothes dryer �•, Clothes washer <br /> Ran e hood �Water heater <br /> Eahaust fan � Sink(servicelbadmopletc.) <br /> Heat pump � BackBow preventer <br /> Unit heater Urinal <br /> Boiler I Drinkin Fountain <br /> Refrigeration I Floordiain <br /> Woodslove \ I Grease trap <br /> � Ductin � Roof drains <br /> � Olher Medical Gas � <br /> SPRINKLER/ SUPPRESSION SYSTEM � Other: <br /> Number of Heads Other. <br /> I l�ere�y certAy I�ol l haw rcatl and eeam�neE lhie npplkotion end knav the fnmo lo�a Iruo onC conect.AA provisiom ot lawa anC oMnoncee goveming Ihis type o/wuM vnA Eo comp4ed <br /> wA�wtmNM specifed herein or nol.Tho gian�inp ol n permii tloea not prosume lo pbo oulnony to dolale o�cancel I�o pro�isbn of any olhe�slme or local law repuWlmp consVuction <br /> Tnnl l em auNotl¢ed by Iha rnvner olt�is pmpeM�o pertartn Ihowod lo�w�kh appGcolbn Is meGe antl I wmply wi�I�a Slela ConUac!on Ww 78.77 RCW an0 79BIOOA WAC. <br /> l!" , � _ _._. .-� ,�/,/iz <br /> �-OwncrlAulhorized Agent Slgnature � 0aie (Revised W201P) <br />