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� <br /> PERMIT APPLICATION <br /> BUILDING/MECHANICALIPLUMBINGISIGN/SPRINKLERIDEMOLITION <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 l � —O e,—`I� <br /> SITEADDRESS: PROPERN7AMN PE MI7s � <br /> ���5 'IZ CK�� � <br /> LEGAL for new cons�ructian: Shorl PlaUsubdivision Lot No._ (attach copy of lon8 legal descriplion) <br /> OWNER I`AN9�� T {3(1-�r Phone/E-mail Y'3-f 3;7�1Vg3 <br /> Address 2�633 Iv ��- � l_5� CitylSlale/ZIP rUEJ�-�TI— �-1A- g �� � <br /> CONTRACTOR L 8 I Lic.K <br /> Address Phone/Email <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> PhonelE-mail <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Ezisting Use of Building �4.5�A�ti' L� _ HEAT SOURCE: <br /> Proposed Use o(Building �� Gas Elociric_ Other_ <br /> Building type: DC Single Family _Duplex_Townhouse _Multi•Family _Commercial <br /> Type of project: _New _Addition _Remodel _Repair_T.I._Sign_Sprinkler�Demolition_Chanc�e ot Use <br /> Descfiption Of Wofk(adtlitional space provided on fhe back): <br /> Tfl�E. r��P�A�c� L�+�µ�..��Y o�� o� No�-s� . <br /> . <br /> Have you started working without a pertnit7 _YES �NO <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> TypeofProJect: _Now_Addn _Altoratlon_Repalr TypaotProJecl: _New_Addn _Altaratlon_Repair <br /> Show Number(N)o//ixtures Show Number(NJ o/flxtures <br /> A/C-air handling units Toilet <br /> Forced air s stems Bathtub <br /> Gas ipin Lavato (wash basin) <br /> Water heater Shower <br /> Gas fire lace Kitchen sink&dis osal <br /> Gasran e Dishwasher <br /> Clolhes d er Clothes washer <br /> Ran e hood Water heater <br /> Exhaust fan Sink(servicelbar/mo /etc.) <br /> Heat pump Backflow revenler <br /> Unit heater Urinal <br /> Boiler Drinkin Fountain <br /> Refrigeretion Floor drain <br /> Woodstove Grease trap <br /> Ducting Roof drains <br /> Other Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM Other: <br /> Numberof Heads Other: <br /> I hereby certify ihat I have read and examineA Ihis application and know�he same to be IruE and conect.All provisions of laws and ordinances goveming <br /> ihis lype of work will be complied with whelher specified herein or nol.The granting ol a permit does nol presume lo give authority lo violate or cancel <br /> Ihe provision of any other state or local law regulating conslruction or Ihe peAortnance of conslruction.That I am au�horized by the owner ol Ihis property <br /> to pedorm Ihe work lor which applicalion is made and I comply wnh Ihe Slale Conlraclors Law 16.27 RCW and 296.200 WAC <br /> ��� ��_ �y/y/�1 <br /> OwnerlAuthorized Agent SlgnaWre Dale (Revised 22017) <br />