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� ` <br /> PERMIT APPLICATION <br /> BUILDING/MECHANICALIPLUMBING/SIGNlSPRINKLER/DEMOLITION <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 �- "�Z <br /> SITE DDRESS: PROPER TAX N Pf�RMI R n <br /> ^� � � c � � �ic�oo���o3 ?��c 1 (� 7 -C� <br /> LEGAL for new conslmction: ShoA PlaVsubdivision Lot No._ (attach copy ol long legal description) <br /> OWNER J, \"S i� PhonelGmail �J—T� 1a-7G <br /> Address �� � + � Cily/State2ip �I n �!l <br /> APPLICANT:_Owner OwnefsAgenl CoNractor _CoNractor'sAgenl 7enantl�rusiv,onaeeier,ercrcon:enirromuew;nerioaowoa�nmesv+cel <br /> CONTRACTOR � � � � U L 8 I Lia# COE Bus.Lia # <br /> Address � � 1 1� `V� � Phone/Email <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> t—}�15_—]�,�, �fc�1 <br /> PhanelE�mail <br /> BUILDING PERMIT A PLICATION CONTRACT PRICE OF WORK <br /> Existing Use of Building HEhT SOURCE: <br /> Proposed Use of Building Gas_ Eieanc_ omer_ <br /> Building type: _Single Family __Duplex_Townhouse _Mulli-Family _Commercial <br /> Type of projecl: _New Addition _Remodel _Repair T.I. Si n_Sprinkler Demolition_Change o(Use <br /> DESCRIPTION OF WORK(atlmriona spacoprovidedontheDack : <br /> . . -��� � � ..��s� �L�� /d� �� � . <br /> /�� , /'��"`_"- , <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type ot Pro�oct: _Now_Atlun _Alleration_Repalr Typa of Project: _Now_Addn _Alteration_Repalr <br /> Show Number(Hl ol lixtures Show Num6er(N)o/fixfures <br /> � AIC—air handling units ' Toile� <br /> I Forced air systems '� �athtub <br /> Gas piping i Lavatory(wash basin) <br /> - � Water heater I. Shower <br /> Gas(ireplace i C�+�itchen sink&disposal <br /> � Gas range i Oishwasher <br /> Clothes dryer � ! Clothes washer \ <br /> Range hcod I er <br /> Exhausl fan �' � Sink(service/badmopletc.) <br /> � Heat pump _ � I BackFlow preventer <br /> Umt heater I Urinal <br /> I Boiler I Drinking Fountain <br /> • !j Refrigeration I Floor drain <br /> Woodstove I Grease Irap <br /> i Dueting ' Roof dreins <br /> � Other I Medical Gas <br /> SPRINKLER I SUPPRESSION SYSTEM Other: <br /> Number of Heads i Olher. <br /> I here0y ceN/y t�at I have read entl eramined Ihie upPllcation ond knew e�e same to be Ime and cormd FII pmvisians ol laws an0 ordinances goveming Ih�s type ol work will�e complied <br /> v:ah whether speutietl�ereln or not T�e BrantinB ol a permA Eoee nol presume to give aul�orny to violate or cancel t�e O�ovision o/any m�er stata or bcal law regulating cansWnio� <br /> Thal I am aol�orizetl by�he owner of Ihls pmDerty lo petlortn t�e work lor HTich applicallon is matle anC I romply rith t�e Slete Coniradors Law f8.27 RCW anC 296 200F WAC. ' <br /> � , / � <br /> /', <br /> p/ � , i ./� <br /> . . ^I /� L� / �L/--/.� T I� ('� � <br /> OwnerlAuthoNud Agenl Signalure alo - (Revisetl6Q012) <br />