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PERMIT APPLICATION <br /> BUILDINGIMECHANICAL/PLUMBING/SIGN/SPRINKLERIDEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES ,3 �-(�—�Z <br /> 3200 Cedar St., Everett,WA 98201 -425-257-8810-FAX 425-257-8857-vwvw.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM B AM TO 4 PM <br /> SITEADDRESS: VROPER7YTAXN PE MIT/ <br /> .. 2-U <br /> LEGAL for new construction: Shorl PlaUsuD0lvision Lot No.= (allach copy ol lonp legal tleeaiptlon) <br /> OWNER ( ��(/_ " – Phone/E�mall 'l t � 7 O" <br /> ddress ^ Ciryl5lale/Zip 7 _ p� <br /> CONTRACTOR ' L&I Lic.# /il'N <br /> ddrese 'ZGLx � =' – ��0� PhonUEmall Z = – <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT ��„ ��(,affr— <br /> ,ns-�.s�y-Isys <br /> • Phone/E�mail <br /> BUILDINGPERMITAPPLICATION CONTRnC7PRICEOFWORK� � Z'•x ' <br /> Existing Use ol Building s HEAT SOURCE: <br /> Proposed Usa ot Building S�ti6� Gas Elxtric Other <br /> Buildingtype: _SingleFamily _Duplez_Townhouse _Multi-Family _Commercial <br /> Type o(project: _New _Addition _Remodel _Repair_T.I._Sign_Sprinkler_Demolition_Change of Use <br /> Description of Work(adtli(bnal space provitled on fhe back): /,_�p�r�/K�,–A�� �bnk �•f' ��~ <br /> �� r <br /> �'«(csla�I /iN.O 9`��.G'� ��/lc�enrc$ - /P[��/L -/Pc-44iFZa %3/ls�ta�/ <br /> Hava you started working wilhout a parmil7 _YES _NO �,,�y� , � ,r.,y� � y <br /> MECNANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Typa of ProJect: _New_AOdn _Alleretlon_Repeir Type ot ProJacl: _Naw_Addn _Altentlon_ Repair <br /> Show NumDer(iq ol llrfures Show NumDer(K)0/flxtures <br /> A/C–air hantllin units Toilet <br /> Forced air s stems 2. Bathtub <br /> � Gas ipin lavato wash basin <br /> � Water heater Shower <br /> � Gas fire lace Kitchen sink 8 dis osal <br /> Gas ran e Dishwasher <br /> Clolhes d er Clothes washer <br /> / Ran e hood I Water heater <br /> Exhaust fan Sink servicelbarlmo lelc. <br /> Heat um Backflow reventer <br /> Unit heater Urinal <br /> Boiler Drinkin Fountain <br /> Re(ri eration Floordrein <br /> Woodstave Grease lra <br /> � Ductin Roof dreins <br /> � Olher Mediwl Gas <br /> SPRINKLER I SUPPRESSION SYSTEM Other: <br /> � Number of Heads � Other: <br /> I hereby certiry t�al I have read and examinea�his appliwiion anA know Ihe same to be Irue and correcl.All pmvisians of laws an0 oMinances goveminp <br /> t�is type ot work vntl be wmpliea wilh wAether speciGed herein or nol.The qranting ol a permit tices not presume to give authanly to violate or cancel <br /> t�e provision of any ot�er slate or local law regutaling conslruction or t�e peAortnance of consUuctbn.T�at I am aulhonzed by t�e owner ol t�ie properry <br /> to peAorm Ine Nork for kh�plication Is maUe and I wmpy with lhe State Contactors Law 18.27 RCW and 288.200 WAC <br /> 1 - <br /> i � Y 2� •z <br /> ner/Aut iorl Agmt Signeture Dale (Revised 1lt0f f) <br /> !� <br />