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PERMIT APPLICATI(yN <br /> BUILDINGIMECHANICALIPLUMBING/SIGN/SPRINKLERID�MOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everetl,WA 98201 425-257-8810 FAX 425-257-8857 w�w.everettm-aaa�l <br /> pPPLICATIONS ARE ACCEPTED FROM B AM TO 4 PM � <br /> PROPfRTV TAl(k P RMIT#D <br /> SITE ADDRESS: � � � <br /> LEGAL br new conslruclion�. Short Plallsuhdivision _Lot No._ (attach copy of long legal descnption) <br /> PhonelE-mail � - � <br /> OWNER <br /> �` .. CilylSlatelZip �• <br /> Address � <br /> APPLICANT: Owner � Ovmer'sAaent .�Conlractor _Con(raclor'sAaenl _Tenantim�sio�o:acoier.e�c!:o�semr�emmeo..�«,�oao..on��mesoacei <br /> L 8 I Lic.# - COE Bus. Lic.# <br /> CONTRACTOR � � <br /> �6 �� PhonelEmail ' � <br /> Address ' <br /> TENANT BUSINESS NA E CONTACT FOR PERMIT <br /> '�t�U�e.1 . � <br /> Phone/E-mail \ � <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK S ��� �-� <br /> HEATSOURCE: <br /> Existing Use of Building_ <br /> Gas Electric_ Other_ <br /> Proposed Use of Building — — <br /> Building rype: �Single Family _Duple/z_Townhouse __Multi:amily _Commercial <br /> Type of projecC _ _New .__Addition y_Remodel _ Repair___T.L_Sign__Sprinkler_Demolition__Change of Use <br /> DESCRIPTION OF WORK(additional space provided on Il�c back): <br /> \�����,�� c.���� :���c.l �� �e,.rc��, <br /> MECHANICAL PERMIT APPLICATION PLUMBING PlRMIT APPLICATION <br /> Type of Pro�ect: _New_Addn .�Alleration_Repalr Type ot ProJect: _New_Addn _Altera�ion_Repair <br /> Show Numbcr(p)o/fixtures Show Number(fl)ol fixtures <br /> A/C-air handlinq units Toilet <br /> Porced air systems Bathtub <br /> � � Gas piping Lavatory(Wash basin) <br /> � Water heater Shower <br /> Kitchen sink d disposal <br /> � Gas 5replace Dishwasher <br /> � Gas ran e Clothes washer <br /> � Clothes dryer Wa�er healer <br /> Ran9e hood Sink(servicelbadmopletcJ <br /> � Exhaust fan B�ckFlow preventer <br /> Heat pump Urinal <br /> � Unil heater <br /> Boiler Drinking Founlain <br /> � Refri eralion Floor drain <br /> Woodstove Grease trap <br /> Roof drains <br /> � Ductin Medical Gas <br /> � Oiher <br /> SPRINKLER I SUPPRESSION SYSTEM Other: <br /> I Number of Heads Olher: <br /> I hereby cenJy thal I have read and examinetl Ous appl¢.1un and Anow the same lo�e Ime antl corrP.tL All prov5ions of IawS and orGiriances goveminy inn 1y0e ol wak will b2 compt�ed <br /> vrAh whelher specdm�h cin o o� The 9ranLnq of a p�nnn does nol precume Io qive nulhorAy�o vnla�e or Wncel�he provision ol any olher sla�e or bcal law regulaiing con5�rut�ion <br /> Thal I am nWt�onze0 b fl :n er ol lhis property�o pedoim tlic wnrA lo�wneh apN�wlan e matle and I comply vnth Ihe Sta�e ConVactors Law 18 P7 itCW and 296.200A WAC. <br /> �f <br /> Date (Fevised 6/2012) <br /> OwncrlAuthorized gant Signaturo <br />