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� <br /> PERMIT APPLICATION <br /> BUILDING/MECHANICALIPLUMBING/SIGNISPRINKLERIDEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 -425-257-88 i 0—FAX 425-257-8857 —www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM B AM TO 4 PM <br /> SITEADDRESS: vnoPeR7viaxa P M��/r � <br /> =i _ ,r'Z— / , E V W - � 70 L. <br /> LEGAL tor new�conslmc�ion�. Short PlaVsubdivision __Lot No._ (altach copy of long legal description) <br /> (�.:�7) 3ti3-G��,3 (r ��e,� <br /> O�YNER i(�� ANN T�{T� /�� Q / J PhonelE-mail _ " � J <br /> Address JJ J�— �J/�v�/ S ( G�GL� � �1� ,�'J CitY/Sta�e/Zip v - �„ ' W1Cu . e1 t I <br /> CONTRP.CTOR Y L 8 I Lic.# �' � �L U��' <br /> i <br /> Adtlress /j,'_ Phone/Email <br /> TENANT BUSINESS NAME ' CONTACT FOR P RMIT�1 <br /> Phone/E-mail �C � <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use o(Bwlding .s�� HEAT SOURCE: <br /> Proposed Use o(Building Gas_ Electric_ Other_ <br /> IBuilding type: �Single Family _Duplex_Townhouse _Multi-Family _Commercial <br /> fype of projecl: _New ✓Addition _Remodel _.Repair_TJ._Sign_Sprinkler_Demolition_Change of Use <br /> Descriplion o(Wo�k(adOrtional space prcv�dedon fhe back): <br /> Have you started work(ng without a permit7 _YES �NO <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT AFPLICATION <br /> Typo of ProJect: _New_Addn _Alterotion_Repalr Typo ai Pro(oct: _Now_Addn _Alterallon_Repair <br /> ShoH•Num6er(N)ol liztarcs Show Nunrber(q�ol fixfures <br /> � A/G—airhandlinguniis I Toilet <br /> Forced air syslems I Balhtub <br /> Gaa piping I Lavatory(�vash basin) <br /> � Walerheater Shower <br /> Gas fireplace I Kilchen sink&disposal <br /> � Gas range Dishwasher <br /> � Clothes dryer � Clothes washer <br /> � Range hood I Water heater _ <br /> � E•haust lan __ I Sink(serviceibar/mopletc_1 <br /> Heat pump I Backflcw pre�renter <br /> � Unil heater Urinal <br /> Boiler Drinking Fo�ntain <br /> Refrigeration Floor dr2m <br /> � � � \Noodstove � G'ease irap <br /> � Duding _ b_of drains <br /> � Othef r:iedi;.alG.s _ <br /> SPRINKLER 1 SUPPRESSION SYSTEM '_`iher: <br /> � Number of Heads I Other: <br /> I hmeby certdy that I have read and examined Ihis application and know Ihe same to be Irue and correct.All provisions of la�vx and ordinances goveming <br /> Ilns type ol work will be complied with whelher specified herein or not.The granling ot a oermit does nol presume lo give aulhority to violate or cancel <br /> R�e provision of any other state or local law regulating wnsiruction or the pedormance of conslruction.Thal I am aulhonzed Sy Ihe owner of Ihis pmperty <br /> io pertorm the work lor which application is niade and I comply wilh lhe State Conlractors Law 1827 RCW and 296200 W�C <br /> _ .,� � � _ 7�— � <br /> / ' i��� (Revisetl71107 t) �� <br /> Owner/Authorized Agent Signature Da�e � <br /> G <br />