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( <br /> PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SI�N/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 -425-257-8810— FAX 425-257-8857—www.everetiwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �QGY/ Z <br /> SITEADDRESS: /S1{'ic SJ/4 PROPEHTYTA p ERMITk <br /> e, � U �so3 a -c� <br /> LEGAL for new construction: Shon PlaVsubdivision Lot No._ (atlach copy ol lang legal tlescription) <br /> OWNER —� <br /> T"! � �i 1 - •.i.,� Phone/Email <br /> . <br /> Adtlress Cily/StalMZip <br /> CONTRACTOR -,�-„ L&I Lic.# <br /> Atldress � (yzrll�iY-�5'F�7 <br /> tc .��.r< a � ,�� � �z Phone/Email y � � � <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> �� <br /> Phone/E-mail t,1t�y �-�,�� �- > �o �,7Jal•cr� <br /> BUILDING PERMIT APPLICATION coNrRacT rRice oF woRK_I �� 04�l- <br /> � <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building ���� 1c }'a...��•� 2e� o �a- Gas Electric k Oiher <br /> Building type: ,�Single Family _Duplex_Townhouse _Multi-Family _Commercial <br /> Type of project; �CNew _Addition _Remodel _Repair_T.I._Sign_Sprinkler_Demolition_Change of Use <br /> Description o(Work(adddional space providad on Ihe back); <br /> ;11EU S/NLLE I=qq7l�Y �f�Clf.�c€ �So��C�� <br /> ���F � <br /> Have you started working wilhout a permft4 _YES _NO <br /> MECHANICAL PERMiT APPLICATION PLUMBING PERMIT APPLICATION <br /> TypoolProJect: �Now_Addn _Altaratlon_Rapair TypoofProJoct: _Nuw_Addn _Alteration_Repalr <br /> Show Number(pJ o//ixfurcs Show Numbcr(N)olOxfures <br /> / A/C-airhandlin units Toilet <br /> Forced air s stems Bathtub <br /> Gas piping Lavatory(wash basin) <br /> 1 Water heater Shower <br /> Gas fireplace / Kitchen sink 8 dis osal <br /> Gas ran e Dishwasher <br /> ! C'olhes dryer Clothes washer <br /> / Range hood Water heater <br /> H Exhaust fan Sink(service/bar/mop/etc.) <br /> Heat pump Backflow preventer <br /> Unit heater Urinal <br /> Boiler Drinking Fountain <br /> Pefrigeration Floor drain <br /> Woodstove Grease irap <br /> Ducting Roof drains <br /> � Other Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM Other: <br /> Number of Heads I Other: <br /> I hereby cetlily thal I have mad and examinetl Ihis application and know Ihe same to be Irue and conecl.All pmvisions ol laws and ordinances goveming <br /> �his type o ill be complied with whether specifietl herein or not.Tha granting of a permit docs nol presumo to give authonly to violata or cancel <br /> Ihe pro sion of an olh r stat or local law regulating constructlon or the pedormance ol conslruction.Thal I am authonzed by Ihe owner ol lhis pmperty <br /> to pe orm�he work or ch plication is made and I comply with Ihe Slate Contractors Law 1827 RCW and 296200 WAC <br /> — 1I� <br /> �� /2 <br /> O or/ horized on IgnaWro Date (Revised?/I011) <br />