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PERMIT APPLICATION <br /> BUILDING/MECHANICAUPLUMBING/SIGNISPRINKLERIDEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES �—I°I "!1 <br /> 3200 Cedar St., Everett,WA 96201 -425-257-8810–FAX 425-257-8857–www.everetlwa.org <br /> pPPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITEADDRESS:^ PROPERTYTA%p M�T�Q �D�" <br /> 2 2� u� ' �=n` <br /> LEGAL for new construction: Shah PlaVsubdivislon Lol No._ (atlach copy ol lonp legal description) <br /> OWNER {/��/ C� G/7��0i(�� S ��/l��� Phone/E•mail�.Cs�-/�f7- ��.57 G'/1�Zv�1�A�tU � � '� <br /> Atldress �� SC ,�� � � City/5latelZip�rl�-�V[ � w 6n0 <br /> CONTRACTOR � L� C / LC.J L 8 I Lic.# O�f/ � <br /> Address Phone/Email y-2.7 - �f'/�' �^ 7 <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Phone/E•mail <br /> BUILOING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building Gas_ Electric Olner <br /> Building type: _Single Family _Duplex_Townhouse _Multi•Family _Cornmercial <br /> Type of projecl: _New _Addition _Remodel _Repair_T.I._Sign_Sprinkier_Demolition_Change of Use <br /> Descriplion of Wofk(atlCRional space provitled on tAe beck): <br /> IZL RDD� <br /> Have you ataAed working without a permit7 _YES ,�NO <br /> MECNANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type o1 Project: _Naw_Addn _Alterotlon_Repair Type of ProJeet: _New_Addn _Alteratlon_Repair <br /> Show Number(M)o//ixtures Show NumDer(�)o/flxtures <br /> A/C-airhandlin unils Toilet <br /> Forced air s stems Balhtub <br /> I Gas pipin Lavato wash basin) <br /> Water healer Shower <br /> Gas fireplace Kitchen sink&dis osal <br /> Gas range Dishwasher <br /> Clolhes dr er Clothes washer <br /> Ran e hood Water heater <br /> Exhaust fan Sink(service/bar/mop/elc.) <br /> Heat pump Backflow reventer <br /> Unit healer Urinal <br /> Boiler Drinkin Founlain <br /> Refri eration Floordrain <br /> Woodstove Grease trap <br /> Ducting Roof drains <br /> Other Medical Gas <br /> SPRINKLER I SUPPRESSION SYSTEM Other: <br /> Number of Heads Other: <br /> I hereby certify Ihat I have read and examined Ihis applicalion and know Ihe same lo Ce true and cortecl.All provisions of laws and ortlinances goveming <br /> ihis type o1 work will be complied with whether specified herein or not.Tha granting ol a pertnit does not presume to give aulhority lo violate or cancel <br /> Ihe provision of any other state or local law regu�ating construction or Ihe peAortnance of conslraction.That I am authorized Cy�he owner of Ihis prope�y <br /> to pedorm Ihe work lor which application is matle and I comply with Ih�Stale Conlradors Law 1827 RCW and 2982�0 WAC <br /> � � - '", Cf—/G%�// <br /> j� �-�, �_ ��.�, �!�-� <br /> OwnerMu orized ge Signa re Date (Revised7lS01f) <br />