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PERMIT APPLICATION <br /> BUILDING/MECHANICALIPLUMBINGISIGNISPRINKLERIDEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everelt, WA 98201 -425-257-8810— FAX 425-257-8857—www.everettwa.org <br /> qPPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITEADDRE55: PnOPEaivTn%a E MITa <br /> S�I�i �Sf ��. P '�" � � <br /> LEGAL lor new conslruciion: Shorl PlaVsubdivision Lol No._ (���ach copy ol long Iegal desaiption) <br /> OWNER �71G�' �Cll�hY -� �C'y'7�-1 Phone�E-mail pl s� ��G� �7J � <br /> Addmss �, '� f� p► • w�V ' CitylStatc/Zip � ��"TT (,(/tY � <br /> CONTRACTOR /'y Y �1� �G�t Y� L&I Lic.# ^� �ih' <br /> Add�ess �73U 3 7Gty QY• f✓[/�' ��QtiWO � q8'�S� PhonelEmail p�S' �J7U��G� <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT 3 Ga -�5�-3as� �• <br /> �y,�r -8�o-v�is �e�� <br /> Phone/E-mail 'j'Cl�c ) � C1� <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK � JQO •d ' <br /> Existing Use ot�uilding HEAT SOURCE: <br /> Proposed Use of Building Gas_ Electric_ Other_ <br /> �uilding type: _Single Family _Duplex_Townhouse _Mulli-Family _Commercial <br /> Type of projecC _New _Addilion _Remodel _Repair_T.I._Sign_Sprinkler_Demolition_Change of Use <br /> Descriplion ol Work(adtldional space provitled on fhe back�: <br /> ��� k�ci��'j ���Jti'� �0�1 SQ` �J��t <br /> Have you started working without a permilT _YES �NO <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type ol Pro�ect: _New_Addn _Alteration_Repalr Typa of ProJoct: _Now_Addn _Alloratian_Ropalr <br /> Show Nunr6er(N)ol lixtures Sfraw Numbcr(N)ollixtares <br /> A/C—air handling units i Toilet <br /> � Forced air syslems Bathtub <br /> I Gas piping I Lavalory pvash basin) <br /> � Water heater � Shower <br /> � Gas fireplace Kitchen sink&disposal <br /> � Gas range � Dishwasher <br /> � Clothes dryer Clolhes v:asher <br /> Range hood � Water heater <br /> Exhaust(an Sink(servicelbadmopletc.) <br /> I Heat pump � Backflow prevenler <br /> Und heater Urinal <br /> 6oJer Drinking FouMain <br /> ReGigeralion Floor drain <br /> � Woodstove � Grease trap <br /> � Ducting � Roof drains <br /> � Other Medical Gas <br /> SPRINKLER I SUPPRESSION SYSTEM I otner: <br /> � Number of lieads I Other: <br /> I I�,eie6y cetlify Ihat I have read and esamined Ihis applicalion and know Ihe same to be Ime and correcl.Ail pmvisions ef laws and ordinances goveming <br /> th�s lype ol work will Ge complied wiih�vhether specified herein or not.Tho granling ol a pertnil tloes not presume to give authority lo violate or eancel <br /> the pm ion ol any other slate or lowl law regulating conslmclion or the pedormance ol constmctioa Thal I am authorized by Ihe o�.vner of Ihis propeAy <br /> �o p� r whic pl calion is made antl I comply with Ihe State Contraders La�v 1827 RCW and 29fi100 WAC <br /> ,����--2_ �_O��� � i <br /> urlAulhorized Agent Signature Dale (Revisetl711017) /� <br /> ! <br />