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PERMIT APPLICATION <br /> BUILDINGIMECHANICALIPLUMBINGISIGNiSPRINKLERIDEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 -425-257-8810-FAX 425-257-8857-w�✓.evere/ttwa org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �O `/ � � <br /> PROPCftTY TA%N PERh1�T M <br /> SITEADDRESS: � . . 1 .� ( ���,/. ;r [� ^l'D 4f�0 � U�]�G�1 <br /> �� i„ t� ���, v �r , , <br /> ':( , �- - ,,��cr <br /> IEGAL�or new wnstmcbon Short P�a.'subdrvision � � � �c�c�iTrpo� No� (attach wpy ci iong ie3ai descr�ntion)�•,-� - <br /> J <br /> OWNER t'.�•. � . . ( � " .('�1� 1 Phone/6ma�l � %c .:.c�,. ., �.•f�e_ <br /> [� � <br /> Address �/� C� �' I� � l .�1� Gty/S(atelZip C � '( �( � '" �/ �,C <br /> CONTRACTOR f i. J , � L 3 I Lic # <br /> Phcnn�Ema�l <br /> �daiess '� : , . ,' � <br /> TENANT BUSIN[SS NAME CONTACT FOR PERMIT �(„ :.i� - y lt(—( <br /> � l <br /> PhonelEmad '1 I � . ',�� `� � <br /> BUILDING PERMIT �.PPLICATION CONTRACT PRICE OF WORK <br /> i�, <br /> Exisling Use of Ouilding__ �' ° � - ` ��- � �' '� HEAT SOURCE� <br /> Proposed Use of Building '"'/��f Gas 7� Electnc Otner <br /> Building rype: ,�Single Family _._Ouples_Townhouse _Mulli-Family _Commercial <br /> Typc ol project: _New ,_Addition _,Remodel _Repair_T.I._Sign_Sprinkler_Demoht�on_Change of Use <br /> Descriplion of Work(addrt;owl space prowded on Ihe bacN)� <br /> ��I'.. �.t . � . . � i � ' � �' � � � . -_ <br /> � � . i � <br /> Have you started workin�Nithoul a permit^ _YES �.NO <br /> MECHANICAL PERMIT APPLICATION PLUMF3ING PERMIT APPLICATION <br /> Type of Pmjecl: _Ne.v_Addn _Alleralion_Repair Type ol ProjecC _New_Addn _Alteration_Repair <br /> Shaw Numbcr fM)o(lixrores Shaw Numbei(N)ol/ixlums <br /> � NC—air handlin� units iodet <br /> Forced air s ste:ns � Balhtub <br /> Gas pipin Lavatory Iwash basin) <br /> li Wa�en c�ater , Show=_r <br /> I Gas fireplace Kdchen sink 8 disposal <br /> Gas ran e Dishwasher <br /> Clothes d er Clolhes washer <br /> Ran e hood I Water heater <br /> Exhaust fan I Sink(sorvice/tar/moplet[.) <br /> I Heat um I f3ackflow P�evcNer <br /> Unil hea:er I Urinal <br /> i Boiler Dnnkin Founlain <br /> Relnneiation Floor dram <br /> � � VJoodstove , <br /> Grease lrap <br /> ' Ductin � Root drains <br /> Oiher <br /> � Medical Gas <br /> SPRINKLER I SUPPRESSION SYSTEM � Jmer <br /> Number ol Heads Other <br /> I hereUVi ceNty that I have read and e*amined�his ap0liwLnn and hnow the same to he true an�conect All pmvisions of I.��+s and aJ�,nances govem��rg <br /> th�s lype ot work xvll be complied with�Melher specfie0 here��or not.The granhng ot a pe�mit does not presume to gne au;ho�dy;o cz'a;e cr cancel <br /> Ihe provision of any oth�sT�te or loeal iaw regula0ng wnstrudion or the pedormance of rnnsh�ction That I am authonzed ty Inc c:.:��a c'2�.��s��c,c-nr <br /> �o F-�o��he vArk lo �w1uUi aaDlicauon is made and I wmply vnN the State Contractors Ww 19 27 RCW antl 296 200 INAC <br /> � �� �' — �j' -- � ( � �._�•;, <br /> , ., -_ �, � , <br /> Owncr'Au�horized A9ent Signalure <br /> � oat, i�_,.s:.-, <br /> � <br />