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PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLERIDEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, V�iA 98201 -425-257-8810—F.AX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED Fi:OM 8 AM TO 4 PM 6 - a b--�Z <br /> SITEADD� SS' PROPERTYTA%k PERMIT ' <br /> ., ` G"•t���� C� 5 S <br /> LEGALIornewconslruction�. ShortPlal/subdivision____ _____ ___________--___LotNo.___._ (altachcopyoflonglegaldescription) <br /> OWNER ; )! � � �������-' PhonelF-mail <br /> cq' <br /> Address��� ,' �� �.. � ��� � CitylState2ip � %V� ! I(/ <br /> CONTRACTOR � � ,��Q� -(..(-V� �1C �;� C��.���i'11 L81Lic.# ��: -i �/i� / .�� 7L,� <br /> nddress� "f�(i ' " SL7��l f���L�+�ffr� '��'7- ��'ZO'� Phone�Emai��� / /�/�'f � -- <br /> TENANT BUSINE S NAME CONTACT FOR PERMIT '�""J `(' /�/rJ <br /> / /�IlL,LC_ 1�1 <br /> �( � �/ �' ('UV�— PhonelE-mail JS � i �y' <br /> BUILDINGPERMITAPPLICATION CONTRACTPRICEOFwoRK1 ��—__—____—__— <br /> Existin Use ot Buildin HEAT SOURCE: <br /> 9 9------------------------------- <br /> Proposed Use o(Building_______ Gas____ Eiectnc____ Other____ <br /> -------------- .� <br /> Building�ype: ___Single Family ___Duplex___Townhouse ___ Multi•Famil�_ Commercial <br /> Type of projecC _ _ New ___Addilion ___ Remodel ___ Repair__T.I._�_Sign_ _Sprinkler___Demolilion_ _Change of Use <br /> Descriplion of W ork(additional space provided on fhe back): , :�G, .. , <br /> ���� S�(.i1� ��1i�t'.- �! Gc; ��-�`�' <br /> Have you slarled working without a permil? _ __YES T,0 <br /> MECHANICAL PERMIIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type ol ProJect: _ ._New___Fddn .__Alterotlon__.Repair Type of ProJeck ___Now__ Addn _ _Alteratlon__.Repair <br /> Show Numbcr(k)o(/lxtwes Show Numbcr(A)o�fixfures <br /> NC—air handling units Toilel <br /> ' Forced air s slems ' Bath�ub <br /> � Gas pipin �� Levato (wash basin) <br /> � Wa�er heater ' Shower <br /> j Gas(ueplace �I; Kitchen sink 8 dispesal <br /> Gas iange 1� I Dishwasher <br /> � I� Ciothes dryer � I Clolhes washer <br /> � Range hood 1 i Water heater <br /> �� Fxhaust(an � ' Sink(service/bar/mop/elc.) <br /> i � Heat pump <br /> Backflow preventer <br /> � Uni�heater ' Urinal <br /> Boiler I ��� Drinkin Founlain ��. <br /> � Re(rigera�ion I I Floor drain <br /> Woodstove I I Greaselrap <br /> � Ducting � � Roof drains <br /> ' � �I Medical Gas <br /> . . Other----------- <br /> SPRINKLER / SUPPRESSION SYSTEM I Other. <br /> Number of Heads � Olher. <br /> I hereUy cenify thal I have�e3d and examined this application and k.nmv Ihe same to be tme and wrrect.All provisions ot laws and ordinances go�erning <br /> tlus type ol work will be c�nnphed with whether specified herein or nol.The granting ot a permi;does not presume to give authonty�o violate or cancel <br /> the provisioh of any other slate or local law regulating conslruction or the pedormance of construction.Thal I am authorized by the owner oi this property <br /> to pe �m'he�t,rk for which applica�ion is made and I comply with lhe State CoNractors Law 1827 RCW and 296.20D WAC <br /> / � �i <br /> / � �/ �� �� �. ����� C__ <br /> �OwnodAuthodzed7igent Slgnature ��— (Revised 2/2011) �/Z <br /> �_i <br />