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PERMIT APPLICATION <br /> BUILDINGIMECHANICAL/PLUMBINGISIGN/SPRINKLER/DENIOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett,WA 98201 -425•257-8810—FAX 425-257-8857—wmv.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITEADDRE 5: PflOPEflTlTA%q �T� _J <br /> nC� �uck� �- f�v � a <br /> LEGAL br new mn.truction: Shoh PlaVsubCivislon Lol No._ (altach copy of�ong legal description) <br /> r <br /> OWNER �Y Ev � � C 'Ct jCt�- Phonc/E-mail J('-(�.-j . '3'�(� C7�(C �C� 0�) ` uNJ• +�'1 <br /> ?:: � Cit /SIatMZi � � <br /> Adtlteu � 2✓' �1 N�' � t�� 7r Y P e[i IYIC I, 9 I � <br /> CONTRACTOR CA!n r L 81 Lic.# <br /> PhonGEmail <br /> Adtlmss <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Phonel6mail <br /> BUILDING PERMIT APPLICATION CONTI2ACT PRICE OF WORK <br /> HfAT SOURCE: <br /> Exisling Use of Ouilding C-i � � ;�jt.��o/.' — <br /> PwposedUseofBuilding Tv 1JCt�+tc` I,i9 � Gas_ Etectnc_ Other_ <br /> Buildingrype: _SingleFamily _Duplez_7ownhouso ,_Multi-Family _Commercial OcTn.cl��� G�<✓c. �e <br /> Typeoiproject: _New _Addition _Remodel _Repair_T.I._Sign_Sprinkler�Demolition_Change ofUse <br /> Descfiplion of Work(adtlitional spare provitletl on fhe back): <br /> v<• ,.,� c:. , ,,, �� <br /> Havo you slarted working wilhoul a permit7 _YES NO <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> TypeofProJect: _New_Addn _Alterallon_Repalr TypoolP�oJect: _New_Addn _Al�eratlon_Repalr <br /> Show Number(al o!/Istures Show Number(N)o//7.rfures <br /> A/C-airhandlingunils I Toilel <br /> � forced air systems Balhlub <br /> � Gas pipin � Lavato wash basin <br /> � Water heater Shower <br /> I Gas fireplace Kitchen sink 8 disposal <br /> Gas range Dishwasher <br /> Clothesd er Clolheswasher <br /> Ran e hood Waler heater <br /> Exhaust fan � Sink(servicelbar/mo /elc.) <br /> Heat oum � Backflow reventer <br /> Unit heater Urinal <br /> �oiler Drinkin Fountain <br /> Refrigeration Floor drain <br /> � Wuodstove Grease Ira <br /> � Ductin Roof drains <br /> � Olher Medical Gas <br /> SPRINKLER I SUPPRESSION SYSTEM otner: <br /> � Number of lieads I Olher: <br /> I here6y ceniy that I have reatl and e.amined this applicatlon and know Ihe same to be irue and correct.All provisions ol laws antl ordinanws goveming <br /> Ihis typo ol work will�e complied xith xTe�her speciGed herein or not.The gmnting ol a permil tloes nol presume to give aulhonty to violate or cancel <br /> ihe provision ol any olher stale or local law regula�ing conslruction or Ihe pedormance ol consiruction.That I am auNonzed by the awner of this properiy <br /> lo Feriorm the urork lor�vhich applicalion is made and I comply w�ih Iho State Coniractors Law 18.27 RCW and 298.200 WAC <br /> �" i� <br /> %i{.C` `-���', .('�'�"�'`-` � /c�� 2 t�(`� (Revised 7iZof il <br /> OwnedAuthotlzed A9ent Signalure Oate <br />