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PERMIT APPLICATION <br /> BUILDINGIMECHANICAL/PLUMBINGISIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 -425-257-8870—FAX 425-257-8857—www.everettwa.org <br /> ppPL�CATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITEADDRESS: • PROPERTYTAXp �P MiTR _ <br /> HS( ie� � <br /> LcGAL for new construclion: Short PlaUsubdivision lol No._ (altach copy ol lonp legai descnplion) <br /> OWNER �, PhonelE•mail 'Z,S-3���0�{� GL •C� <br /> Address �p� y�C(,J �. CitylSlatelZip (�U (�,� � <br /> CONTRACTOR ratST Y aC C. L&I Lic.# S E. �1 <br /> Address �N�S ��� �U UA1 Phone/Email yt�' —y$2� �,(p <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Phone/E-mei� ��- —�u. <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK �� <br /> Exisling Use of Building � C HEAT SOURCE: <br /> Proposed Use of Building 5�.1.�— Gas Electric Other_ <br /> Building type: ✓ingle Family _Duplex_Townhouse _Multi-Family _Commercial <br /> Type of project: _New _Addilion _Remodel _Repair_T.I._Sign_Sprinkler_Demolition_Chenge ot Use <br /> Description of Work(adtlifionel spaca provided on the back): <br /> 2L ��o-F <br /> Have you slarted working without a pertnit? YES ,_NO <br /> MECNANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> TypoolProJe�t: _New_Addn _Alterallon_Repalr TypeolProJe�t: _New_Addn _A:teration_Rapeir <br /> Show Number(N)o!/ixtures Show Number(Nj o(Ilxtures <br /> A/C—air handlin unils Toilet <br /> Forced air s stems Ba�htub <br /> Gas ipin Lavato (wash basin <br /> Water heater Shower <br /> Gas fireplace Kilchen sink&dis osal <br /> Gas ran e Dishwasher <br /> Clothes d er Clothes washer <br /> Range hood Water heater <br /> Exhaust fan Sink(service/barlmop/e�c.) <br /> Heal pum Backflow reventer <br /> Unit heater Urinal <br /> Boiler Drinkin Fountain <br /> Refri eration Floordrain <br /> Woodstove Grease trap <br /> Ductin Roof drains <br /> Other Mcdiral Gas <br /> SPRINKLER I SUPPRESSION SYSTEM other: <br /> � NumberofHeads Other: <br /> I hereby certify Ihat I have read and examined Ihis applicallon and know Ihe same to be Irue and covecl.All pmvisions of laws and oMinances goveming <br /> Ihis type of work will be complied with whether specifed herein or not.Tho granling ol a pertnil does not presume to give authonty to violate or cancel <br /> the pmvision of any other stale or Iocal law regulating conslruction or Ihe pertormance of construclion.Thal I am authorized 6y the ovmer of this propeity <br /> to peAo t lor wh' h application is made and I comply wilh Ihn State Contractors Lew 78.27 RCW and 296.200 WAC <br /> C��/`��8� S�a.a.- /l <br /> Owne�rizad Agent Signature Dale (Revised 7lt0f 1J <br />