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r� <br />V <br />� <br />PERMIT APPLICATION <br />BUILDINGIMECHANICAL/PLUMBINGISIGN/SPRINKLER/DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8657 www.everetlwa.org <br />APPUCATIONS ARE ACCEPTED FROM ! AM TO 1 PM <br />lor new consUuction'. Short PlaOsubtlrvislon__ lol No._ laltec� copy of long Icgal descnOUon) <br />_Owner _OwneYSAgenl �Conlractor _ConlraclorsAgenl _Tenant��sio�o.me.bnwdcrnsmixa�mew�e.uao..orrnm.yew) <br />l R I Lic. # COE Bus. Lic. # <br />qG•Yf 1 GONTACT FOR PERMIT�p <br />�a0"P � �t P,'a� <br />PERMIT APPLICATION �CONTRACT PRICE OF WORK <br />Ezis�ing Use of Building S f7� HEAi SOURGE: <br />Proposed U5e of Building �rl� Gas Electric Other_ <br />Building lype�. �i Siagle Famdy _ Duplez _Townhouse _ Multi-Family _ Commercial <br />i <br />7ype of project _ New _ Addition _ Remodel _ Repair T.I. _ Sign _Sprinkler _Demolition Change of Use <br />DESCRIPTION OF WORK (atldmonal space orov� ed on �ha back : <br />�:�� ry-o o�-�k � f�p� l <br />MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APF;ICATIO <br />TypeolProjecl: _New_Addn _Alteration_Repair Typ�plProject: _New_Addn _Alteratlon_Repair <br />S�ow NumOer (d) o/lrtures Show Number (pJ oI flrturet <br />AIC—airhandlinaunits I Toilet <br />basin <br />Clolhes washer <br />Water healer <br />Sink (service/oz <br />Floor <br />Roof drains <br />Medical Gas <br />Other <br />I he.e0y cenM inat 1 have rcad antl e�amineE Nis apoM��ron ana know �M1e same to Ea Ime anE cortect. a� omvisans al Wws an0 oNlnancec goveming Urs type ol woh wip pe cand�e0 <br />xn� xfieUrtr apecRieC M1wein o� nal. The gOntmg o� a pe�n Goes �ol prezumc m give autha�rty lo vio4la m cancel lne pmviabn o1 any ol�er state w loral Ww regulaling tonsvuqan <br />T�at I am aN�orlxeE Ey I�e owne o� I�is Omperty to perlarm �ne wqM lo� wh� aOG�a�bn is msEe anE 1 comDN ""U ��e Stale Comrottors Law 1b 27 RCW and 7%.200q WAC. <br />�.� , � � �9 �y l <br />Own rlAuthoN:eA Agent Signa u e ate (Revised 6/T012) ` l <br />L <br />