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PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLERIDEMOLlTi'�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 320D Cedar St., Everett,WA 98201 -425•257-8810—FAX 425-257-8857—www.everellwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS: PROPERiY TAl(p P RM T R� _�Z <br /> � rewc�z��sr av = <br /> LEGAL for new conslructlon: Short PlaUsubdivision Lot No._, (attach copY ot long legal descriptlon) <br /> OWNER I�11 A � (' 2L PhonrJE-mail �G S�' '�'�`� S <br /> ddress � '7_� — C. ` /�-VC;� Ciy/Slale/Zip EVc=2�7T � <br /> CONTRACTOR ,r F/� �,2 L 81 Lic.# .T F KA <br /> dOresa ' .'jQ S i cnie A��e N PhoneJEmail J�-�/rn v.�4•- <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT�� �� �L, �y��pL'(� <br /> PhonelE•mail ��z J" — �� —�J� <br /> BUILDING PERMIT APPLICATION CONTRACTPRICEOF WORK/ l'r�'� r�<� <br /> 6clsling Use of BuiMing HEATSOURCE: <br /> Proposed Use of Bu'ding Gas � Eiectrir._ other <br /> Building type: Single Fami�y _Duplez_Townhouse _Multi•Family _Commarciai . <br /> Type of proJect: _New ��Addilion _Remodei _Repair_T.I._Sign_Sprinkler_DemoliUon_Change ol Use <br /> Descriptlon of Work(sddifional sp me provided on fhe backi: <br /> ��L�>� rso,;i or C-r:� s r�z�-rz=/� <br /> Have you started working wilhout a permlt7 _YES �O <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> TypeofProJect: _New_Addn _Alteralion_,Repalr TypaolProJecl: _New_Addn _Altantlon_Repair <br /> Shaw Number(7�1 0l tlutures Show Number(M)a!Orfures <br /> A/C—air handling units Toilet <br /> Forced air s stems Balhtub <br /> Gas i in Lavato wash basin <br /> Waler heater Shower <br /> � Gas fire lace Kitchen sink 8 dis�asal <br /> Gas ran o Dishwasher <br /> Clothesd er Cbtheswasher <br /> Ran e hood Waler healer <br /> Exhaust fan Sink servicelbarlmo /etc. <br /> Heat um Backflow reventer <br /> Unit heater Urinal <br /> Boiler Drinkin Fountain <br /> Refri eralion Floordrain <br /> Woodstove Grease lra <br /> Duclin Roof drains <br /> � Other Medical Gas <br /> SPRINKLER/SUPPRESSION SYSTEM Other: <br /> NumberofHeads � Olher: <br /> I hem6y certiry t�at I havo rea0 end ezamined Ihis app�ication end know the same lo he Iruo ana corrttt.All provisions of laws and oNinances poveming <br /> Ihis type of wo�k will 6e wmplieA wlh whelher specified hereln or no!.Tha granting ol a permit does not presume�o glve aulhonty ta violale or wncel <br /> Iho provislon ol ary o�het slata or laal law tepulaling con5imctlon oi the peAortnance o(ConSW�Uon.That I am authotlzed by lhe owner ol IMe properry <br /> to pertorm jhn ww�k fw wh�ch appJu:e6on le made�and I compy with!he SIaIe Conl2ctors Law 10.P7 RCW and 288.2U0 WAC <br /> - � /��'="����� � ����� (RevisedL2011J <br /> Owner/Authorized Agenl Slgnatura �ala <br />