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� <br /> PERMIT APPLICATION <br /> BUILDINGIMECHANICAL/PLUMBING/SIGN/SPRINKLERIDEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 -425-257-8810—FAX 425-257-8857—www.everetriva.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS: PROPERTY TAX N RMIT K <br /> ��iZ iZ.:c�c�el�r� 5 - � 1 �- <br /> LEGAL for new construction: Short Plal/subdivision Lol No._ (attech copy ol long legal descriplion) <br /> OWNER ��^' '� 'J���{' S�l�,%'r PhonclE-moil <br /> Address ��IJ. �Z:Jc.4�Gi�G��C.R.- CitylSlalelZip �Jt',2(,T( ��� p��% <br /> CONTRFCTOR `�D�� L��S�IZ�M7i�'� o• �� �" �' L&ILic.# '�JI �(.,CC, /v�'I� 1 ` W <br /> Address Z Z ZS 1C.:1-��'FC(��� (..'��"'�/ �r-� � c)7(V � PhonelEmail (Z��C) �541 - 3�/ I <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT �u�7G I �i�� � <br /> . / Z 1 <br /> PhonclE-mail ��u �� l�` I <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK 3 ���' <br /> Exisling Use of Building _ HEAT SOURCE: <br /> Proposed Use of Building �'�2n� Gas_ Eledric__ Olher__ <br /> Building type: _Single Family _Duplex_,Townhouse _Mufli-Fami!y _Commerciul <br /> Type of projecl: _New _Addition _Remodel _Repair,_T.I._Sign_Sprinkler,Demolition_Change of Use <br /> Desc�iption of Wotk(�dditionol spaco provided on fhu back): ( � ;�C�� /�,G;. _ ^ _ <br /> I�..�-:� ��- � ,.,� <br /> �� <br /> Have you started workfng wilhout a permit? _YES �NO <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Typo of ProJecl: _Now_Addn _Altoratlon_Rupalr Typa of ProJecl: _Now_Addn __Alteralion_Ropair <br /> Show Number(pi ollixtures Show Number(N)of flxturee <br /> A/C—airhandlinguni�s I Toilet <br /> � Forced air s slems Balhtub <br /> � Gas piping Lavalo (wash basin) <br /> Water heater Shower <br /> Gas fireplace Kitchen sink 8 disposal <br /> Gas range Dishwasher <br /> Clothes dryer Clolhes washer <br /> Range hood I Water heater <br /> [xhaust far� Sink(servicelbar/m�p/etc.) <br /> Heat Fump � Backllow preventer <br /> Unit heater I Unnal <br /> Boiler I Orinkin Four.tain <br /> Refrigeration F�oor drain <br /> Woodslove � Grease lrap <br /> Ducling � Roof drains <br /> Other Medical Gas <br /> SPRINKL[R 1 SUPPRESSION SYSTEM Other: <br /> � Nu,nber of Heads I Olher. <br /> I hereby certily that I have read and examined�his aFP�ication and kno�r the same to be Irue and cortect.All provisions ol laws and ordinances goveming <br /> Ihis lype ol woih will be wmplied wilh whMher specifed herein or nol.lha granting of a pemiil tloes not presume tu give aulhority la vlolate or cancel <br /> Ihe pmvision ol nny other ale or loc�l9nw m9Watin�consWclion or tne pedarmance ol construction.Thal i am authoiized 6y Ihe owner of this p�operty <br /> to peAmm�ht�worR lor uch appliption is made and 1 comply wilh Ihe S�ate Conlradors Law 1827 RCW and 296.200 WAC <br /> ;� : ,� 5_ i ,� _ �i <br /> ,; ; C��, <br /> OwnerlAuthorizud Agent Signature Date (Revised 7r2077) <br /> /l <br />