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� � <br /> PERMIT APF'LICA�ION <br /> �. �: • � ::JGlMECHANICAL/PLUMBINGl;�IGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 32C0 Cedar St., Everett, WA 98201 - 425-257-881Q - FAX 425-257-8857 -www.everettwa.org <br /> APPLICATIONS ARE ACC[PTED FROM 8 AM TO 4 PM � �D "'�� <br /> SITE ADDRESS: PNOPERTY TAX N PERMIT b _ OG ' <br /> � a�a� i5 ^ �� .�c <br /> LEGAI tor new construclion�. Shotl PlaVsuhdrvision Lol No._ (�Ilach copy of long legal descriplion) <br /> OWNER Phone/E-mail G�o�-� — S� � — S� �� <br /> Address S 4 �^Q Cily/Stale2ip _ ���Q"I� 1�dr' 9 s a o � <br /> CONTRACTOR— - p/'�-� — ;��wn.p�. _ . ._ ._.__ L"& ILic�# - - -- � � - ------- -- - ----- ----- -- — <br /> Atldress Fhone/Email <br /> TENANT SUSINE55 NAME CONTACT FOR PERMIT <br /> Phone/E-mail <br /> BUILDING PERMIT APPLICATION CONTRP,CT PRICE OF WORK <br /> Existing Use of Bwlding HEAT SOURCF�. <br /> Proposetl Use of Building Gas_ [leclric___ Other_ i <br /> 6mldmg lype� �Single Family _Ouplex_Townhouse _Multi-Family _Commercial <br /> Type of pro�ect: _New _Addition _ Remodel _Repair_T.I. _Sign_Sprinkler_Demoli�ion_Change of Use <br /> DesGfiplion of Woik (ad0�tional space proviCedon fho back)� � <br /> �yi5 c��rn5 c�qJ '. r� 9)< cu In r^ <'So^"� <br /> �1-e Pla <e ( J 0 <br /> I � � 4 S I 1 1'�(L 't0 1'1+ G N�l-� `a �(�_ <br /> Have you started working without a permit7 _YES �NO <br /> MECHANICAL PERMIT APPLICATION PLUMBIN(i PERMIT APPLICATION <br /> Type of ProjecC _New�Addn _Allera.ion_Repair Type ol Projecl: _New__Atldo _Allomlion_Repair <br /> Sho�+Numbcr(N)a!/ixfures Show Numbcr(#)ol lizfuics <br /> NC–air handling unds Toilel <br /> Forced air syslems 13alhtub <br /> Gas pipmg Lavalory(wash basm) <br /> Water heatcr Shower <br /> / Gas fuepiace Kilchen sink 8 disposal <br /> Gas range Dishwasher <br /> Clolhes dryer Clothes washer <br /> Range hood Water heater <br /> Exhaust fan Sink(servicelbar/mop/etc) <br /> Hcal pump Uack(low prevenler <br /> Unil heatcr Unnal <br /> doiler Dnnkiny Fountain <br /> Relri9cration Floor drain <br /> Woodstove Grease Irap <br /> Ductin9 Roof drains <br /> Other Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM othcr. <br /> Nurnber o(lieads Other. <br /> I hereby ceildy Iha�I have iead an0 examined Ihis applir,alion ar 1 know Ihe same lo Ue Irue and coned 411 p�ovisions of lavis anJ ortlinances govmninJ <br /> Ihis�ype ol riork vnll be contp4ed vulh whCther specJieU herGn or nal. ihe granlin9 al a pCrmil doe;not presumr,lo grve aulhori�y lo violale or Cancel <br /> Ihe Dwvision of any olher slale or local law regulnling con;IrucUon or Ihe perto�manC�ol con;imclion Ihat I am aulhomed hy Ihe ovmer ol tliis property <br /> to pertorm Ihc work for wh¢�appliCa�ion 6 matic antl I eomply vnlh ihc State Coniraclors Laei 18 77 RCW anA 296 200 WAC <br /> � �` ��` 3� ` � � <br /> Owned h ited Aycnt Si9naluro Date (Hev�sed7R011) <br />