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PERMIT APPLICATION <br /> BUILDING/MECHANICAL/M�LUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 96201 -425-257-8810—FAX 425-257-8857—Nnvw.eve/rettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM l0— <br /> SITE ADURESS: � � �.� PROVERTY TAX N PE T f <br /> 31 Z5 .`�i <br /> LEGAL for new cons�ruction: ShoN PlaVsubdivisian Lol No._ (altach wpy of long legal description) <br /> OWNER � l ('j�}� �/r�V��� Phone/E-mail � ' 2- - <br /> Address Z 3 I g, Z,�r'�� � City/StatelZip <br /> CONTRACTOR � - L&I Lic.# F/Z f�L'�-- C Z- <br /> Address � �j��j S7�:/�� ��� Phone/Email ZS- s/�- y38 <br /> TENANT BUSINESS NAME CONTACT POR PERMI � {/ � <br /> < <br /> PhonelE-mail l Zs-S��o-y �'C[Y <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building Gas_ Electric_ Other_ <br /> Building rype: _Single Family _Duplex_Townhouse _Multi-Family _Commercial I <br /> Type of project: _New _Addition _Remude� _Repair_T.I._Sign_Sprinkler_Demolition_Change of Use <br /> DesCfiplion of Wofk(addifional space provided on fhe back/: <br /> RL-(.ochru�! af (,-tA-� rcccTC�_ <br /> Have you started workfng without a perm(tT _YES _NO <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Typa of ProJect: _New_Addn _Alteratlon_Repair Typa ot Project: _New_Adtln _Alteralion_Repalr <br /> Show Number(N)o//ixtures Show Number(M)o(/ixtures <br /> A/C-air handling unils Toilet <br /> Fomed air systems BathtuG <br /> Gas piping Lavato (wash basin) <br /> Water heater Shower <br /> Gas fireplace Kitchen sink 8 disposal <br /> Gas range i Dishwasher <br /> Clolhes dryer Clothes washer <br /> Range hood Water heater <br /> Exhaust tan Sink(service/bar/mop/etc.) <br /> Heal pump Backflow preventer <br /> Unit hea�er Urinal <br /> Boiler Drinkin Fountain <br /> Refrigeration Floor drain <br /> Woodslove Grease trap <br /> � Ducting Roofdrains <br /> Other Medical Gas <br /> SPRINKLER I SUPPRESSION SYSTEM other: <br /> Numter of Heads Other: <br /> I hereby certify that I have mad and e.aamined ihis application and know�he same to be ime and correct.All provisions ol iaws and ordinances goveming <br /> this rype ol aork will be complietl wi�h whether specifed herein or nol.Tha granling of a pemil does nol presume to give authority to violate or cancel <br /> Ihe pmvision uf any olher sta�e or local iaw regulating conslmction or Ihe peAormance ol conslruction.That I am aulhonzed by Ihe owner of ihis propeMy <br /> lu pedp}m the work or Ich appl¢a oo's made and I comply�vith the Slale Coniraclors Law 1827 RCW and 296200 WAC <br /> ��. �.����' <br /> �;�-�� <br /> Ownef/ uthorizadAgnntSignature Da�e (Revised2/2011J <br />