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PERMIT APPLICATION <br /> BUILDING/MECHANICALIPLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 -425-257-8810 -FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM Z `Z `�I� <br /> SITEADDRESS: �ROPER7V7\XN P RMI�i _ U <br /> �c /•'dr S� l.l� <br /> LEGf'.L for new conslrucli�n: Shoh PlaVsubdivision Lol No._ (a�lach copy of long legal description) <br /> OWNER r�k [„�p,�n$/t � PhonelE-mail , /, � f.L •F ��..� �/2S�To » ' <br /> Address C' Cily/Sta�elZip y � �2V <br /> CONTRACTOR .:r,..c.r L&I Lic.# <br /> PhanelEmail <br /> Address <br /> TENANT BUSINESS NAME CONTACT fOR PERMIT <br /> Phone/E-mail 4�^t �,v� <br /> BUILDING PERMIT APRLICATION CONTRACT PRICE OF WORK �- �'��� /}'� <br /> Existing Use of Bu�lding_ �4, <br /> ' �l HEAT SOURCE: <br /> Proposed Use ot Building /�a. Gas Electnc_ Olher_ <br /> Building type: ,�Single Family _Duplex_Townhouse _Multi-Family _Commercial <br /> Type of project: _New _,Addition _Remodel _Repair_T.I._Sign_Sprinkler_Demolition_Change of Use <br /> Desctiption of Work(addRional space provided on fhe back): .`cp. ,�i �s f:.i'�•�� �o��2 LffsCS <br /> G(lt`lr�� He��i��i_..RI/ la�nvs �cr L..j"�,�c/,�.�1 <br /> Have you started working withaut a permit7 h YES _NO <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Typa of ProJect: _Now_Addn _Altoration jSRepalr Typo of ProJect: _New_Addn _Alteretlon Htepalr <br /> Show Number(M)o//ixtures Show Number(p)o//ixtures <br /> � A/C—air handling units / ✓ � Toilet <br /> Forced air systems Bathtub <br /> ,�. Gas piping / / I Lavalory(wash basin) <br /> - Waterheater � Shower <br /> � Gas fireplace I Kilchen sink 8 disposal <br /> � Gas renge � Dishwasher <br /> � Clothes dryer Clothes washer <br /> � Range hood � Water heater <br /> � Exhaust fan � Sink(service/barlmop/etc.) <br /> Heal pump � Backflow preventer <br /> � Unit heater Urinal <br /> Boiler Drinking Fountain <br /> Refrigeration Floor drain <br /> Woodstove Grease trap <br /> � Ducting Rooidrains <br /> � O�her Medical Gas <br /> SPRINKLER I SUPPRESSION SYSTEM O�her: <br /> I Number of Heads Other: <br /> I hereby cetlify that I have read and examined this application antl know the same to be lrue and correcL All provisions of Iaws and ortlinances governing <br /> this type of vmrk will be complied with v�helher specifed herein or noL The gran�ing of a permi�does nol presume lo give aulhonry lo violate or cancel <br /> the provision ol any ulher slate or local law regulaling consimction or the pedormance of conslruction.iha�i am authodzed by the owner of this pmperty <br /> to per(orm the vmrk lor� hich applica�ion is made and I comply with Ihe State Contractors Law 18.27 RCW ar.d 296.200 WAC <br /> ��G� ��� j/-aZ• // � <br /> OwnerlAuthorzedAgon Signature Dale (Revised?f1071) I^ <br /> d <br />