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PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBINGISIGN/SPRINKLER/DEMOLITIOlV <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 -425-257-8810— FAX 425-257-8857—www.everetlwa.or <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �-�"I I <br /> SITEAD RESS: PROPERNTA%N PERMIT• <br /> -� " � -, <, � - �tiuti -a <br /> LEGA lor new conslmcti n: Shotl PlaUsu6division Loi No._ (allach copy ol long Iegal descrip�ion) <br /> / � � <br /> OWNER t.�_ . � ��6���'c'.1 � Phone/E-mail <br /> AtlJress .�J �. �� ? ' �. 1G'� Cily/State2iP /jf'�. `. � <br /> CONTRACTOR � � - /?[ , Z! -�S � L 8 I Lic. # <br /> � .l <br /> Addross � �7 L�_ ` �- . /`j' ��' PhonelEmail `�Z�S �G��� ���� �'b � �P�,� <br /> TENANT USINE55 NAM C TACT FOR P���� � ���'t� UI�� � <br /> PhonclE-ma� � — ` (� - -f � , � O�J J <br /> 6UILDING PERMIT APP�ICATION CONTRACT PRICE OF WORK � �'� <br /> Existing Use of Building � �° i ' � - HEAT SOURCE: <br /> Proposed Use of Building . i t)//1�- Gas Electric_ Other_ <br /> Building�ype: _Single Family�j Duplex_Townhouse _Multi-Family _Commercial <br /> Type of project: _New _Addilion _Remodel _Repair_T.I._Sign_Sprinkler_Demolition Change of Use <br /> D crip�ion o(Work(additianal spaco provided oe fhe bnckJ: �= q� � ( fiC �% <br /> ,� i t.�,� c'G� �" G f'x i�s>i�c (� / ) Ln � �� <br /> �/Sr�,�.��.kr • J�- 17 /,r��JIiC��lt��V /%�uC�/f-fI ���+/l7�ON �d�lFlli1 <br /> jliz��i�T��l`�t«/-�_yli,�L� �5 � r%r���1�1// �r�.���� %���/i,,i,�s T <br /> Have you started wor ing without a permft7 _ ES _No� ' "lX <br /> MECHANYCAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> TypooiProJoct: _Now_Addn _Altoratlon_Ropalr TypootProJoct: _Now_Addn _Altorallon_Ropair <br /> Show Num6cr(NJ of/ixtrros Show Number(N)o/Ilxfurcs <br /> NC-airhandlin units I Toilet <br /> Forced air s stems Bathtub <br /> Gas piping � Lavatory(wash basin) <br /> Water healer Shower <br /> Gas fireplace Kitchen sink 8 disposal <br /> Gas range Dishwasher <br /> Clothes dryer Clothes washer <br /> Range huod Water heater <br /> � Exhaust fan Sink(servicelbarlmop/eta) <br /> Hea1 pump Backflow preventer <br /> Uni�heater Urinal <br /> 6oiler Drinkin Fountain <br /> I Refrigeration Floordrain <br /> Woodslove u'rease trap <br /> Ductin � Rooldrains <br /> Other Medical Gas <br /> SPRINKLER I SUPPRESSION SYSTEM Other: <br /> � NumberofHeads I Other: <br /> I 9ereby certily that I have reatl and eaamined Ihis applicatlon and know Iho same l0 6e Iruo and wrrecL All pmvisions ol laws and ordinances goveming <br /> ihis type ol work wiil Ue coinplied wi0�whelher specifed herein or not. fho granting of a pennil does not presume to give aulhorily Io viola�e or wncel <br /> Ihe piovision ol any olher slale or local law regulaling conslruc�ion or Ihe pedoimance ol conslmclion.That I am authonzed by Ihe owner ol lhis pmpe�ry <br /> to pc�form Ihc work loJr wtiich appliwtlon is made and I comply wilh Iho Statc Conlractors Law 18 27 RCW and 296200 WAC <br /> ���7�'//l�J�� �—���� <br /> O�+Mer/AuthorizadAgant Ignaturo Dalc (Revised7/2011J <br />