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PERMIT APPLICATION <br /> BUILDINGIMECHANICALIPLUMBING/SIGNISPRINKLER/DEMOLIT]ON <br /> CITY OF EVERETT PERMIT SERVICES S��y—'� Z <br /> 3200 Cedar St., Everett,WA 98201 -425-257-8810—FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM B AM TO 4 PM <br /> SIT DDRE S: PI�P R7YTAXM � P� �� —O` <br /> � f� <br /> LEGAL for new censlnicllon: Short PlaVsubdiv�sion _Lot No._ (attach copy of long lepal deuriptlon) <br /> OWNE � PhonelE-mall <br /> ddress � � , )'}'� City/SlelG2lp <br /> CONTRACTOR � �� G L 8 I Lic.#Tie C �5�K <br /> dtlrese Q� � �1 �(G�YC 7T P�onnJEmail <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT �J <br /> Phone/E•mail �O�l" lOO <br /> BUILDINGPERMITAPPLICATION CONrRncTPRCEOFwoRK <br /> Exisling Use of Building HEAT SOURCE: <br /> Proposed Use ot Building Gas Eiectric oiner <br /> Building type: _Single Family _Dupiex_Townhousa _MuItI•Family _Commercial . <br /> Type oi projecl: _New _Addition _Remodel _Repair_T.I._Si9n_Sprinkler_Demolition_Chongo et Use <br /> DeSUiptlon o(WOrk(addiNanal space provitled on fhe Dack): <br /> /�L;,�.P�. /�'?-W` ���', <br /> Have you started working without a pertnit4 _YES O <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPIICATION <br /> TypeofProJect: _New_Addn _Alteratlon_Repalr TypeotProJect: _New_Addn _Altentlon_Repeir <br /> Show Num6er(M10l ll.rtuns SAow NumDer(iq ollixfurea <br /> AIC—airhandlin units Toilel <br /> � Forced air s stems Balhtub <br /> Gas i in Lavalo wash basin <br /> Water healer Shower <br /> � Gas fire lace Kitchen sink&dis osal <br /> Gas ran e Dishwasher <br /> Clolhes d er Clothes washer <br /> Ran a hood Water heater <br /> Exhaust fan Sink service/bar/mo /etc. <br /> Heat um Backflow reventer <br /> Unil heater UrMal <br /> Boiler Drinkin Fountafn <br /> ReM ereticn Floordwin <br /> Woodslove Grease lra <br /> Duclin Roof drains <br /> Other Medical Gas <br /> SPRINKLER/SUPPRESSION SYSTEM Other: <br /> Number of Heads Other: <br /> I hereby certity I�al I have read and evaminetl thls applicelion and know t.�same lo be Itue and correc�.All provisbns ol lavn antl ortlinances gaveming <br /> this type of work wlll be mmplied wilh whether specifeA herein or not.The granting ol a permit does not presuma lo give aul�onty to violale or cancel <br /> I�a provision of any ol�er slate or Ixel law regulaling consiructlon or the perlortnance of consWc�ion.Thal l am aulhorized lry l�e awner ot this properry <br /> to petlor Ihu�rork for which aPPliwtion is matle and 1 compy wilh the Stala Conl2clors Law 18.27 RCW and 298.200 WAC <br /> v C/� ��j„� <br /> � <br /> O ner ulhorize Agen Signalura _ Date (Revised 7/2011) <br /> ��Z <br />