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PERlVII'T APPLICA�ION <br /> BUILDINGIMECHANICALIPLUMBINGISIGNISPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES 3 --;(�--/ ?i <br /> 3200 Cedar St., Everett, WA 98201 -425-257-8810—FAX 425-257-8857—www.everettwa.org ry <br /> APPLICATIONS ARE ACCEPTED FROM B AM TO 4 PM CI�L G – O J <br /> SITEAP RESS: � ( – — PftOPERTYTAXN P. MIT <br /> 7� C>S lr.' ��.vo Jc. <br /> LEGAL lor new consimclion'. Shotl PlaVsubdivision Lot No._ W��ach ccpy of long legal CescripHon) <br /> � > � - � U� <br /> OWNER ,� � ' � n �< �)� /r�����i �°"�"�f�'V Phone�E�mail _ — <br /> Add�ess (� � �5�� � V(- �� CitYlStale2ip ��12� � ✓�� �V✓�i ��/ �G�� <br /> CONTRACTOR P L&I Lic.# <br /> Address PhonelEmail <br /> TENANT BUSINE55 NAME CONTACT FOR PERMIT <br /> PhonNE�mail <br /> BUILDINGPERMITAPPLICATION CONTRACTPRICEOFWORK <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Buil�ing_ Gas_ Electric_ Other_ <br /> Building type: �Single Family _Duplex_Townhouse _Multi-Family _Commercial <br /> Type of project: _New _Addition �Remodel`�Repair_T.I._Sigu_Sprinkler_Demolition_Change of Use �� <br /> DesCfiplion 0(WOfk(atlditional space provided on fhe backJ: , -,�.r v��'j L��(,i/[t <br /> ��� �> lc�� i �,�� �'r.,�;; i � e � S `� C. lcc'� Sv�-c e ��' � '� � <br /> � ' � �� � <br /> � �t� ��nu�u��� � ti [C� {r,(.v�4, i�c�������,.� � I,-i �� ��� ' � <br /> V'���� ��C VI� �' <br /> Hav�you started worki�g wilhout a permit7 YES _NO <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMiT APPLICATIQN <br /> Type of ProJect: _New_Addn _A�leraUon_Repair Type of ProJecl: _New_Adtln _Alleralion_Repalr <br /> Show Numbcr(a)o!lixtures Show Number(tl)ollixfwes <br /> � NC–airhandlingunits I Toilel <br /> � Porced air systems I Bathlub <br /> � Gas pipinq I '_avato (wash basin) <br /> � Water heater I Shower <br /> � Gas(ireplace I Kitchen sink&disposal <br /> � Gas range � Dishwasher <br /> � Clothes dryer I. Clothes washer <br /> � Range hood I Water heater <br /> • � I Exhaust fan I Sink(servicelbar/mopletc.) <br /> Heat pump I �ackflow prevenler <br /> � Unit healer � Urinal <br /> � Boiler � Drinking Founlain <br /> � Refrigeration � Floor drain _ . <br /> � Woodsta�e I Grease trap _ <br /> � Ducling � Roof drains _ <br /> � Other � Medical Gas <br /> SPRINKLEIR I SUPPRESSION SYSTEM I Other: __ <br /> I' I Number of Heads � Othec _ I <br /> I <br /> � I hemby certity that I have reatl.ntl eaamined:his��p;liwtion and knmv the same Io b?true and correcC All provisions o'laws antl ordinances govemiog <br /> � this rype m work will be complied wi�h whelher:peci'ietl�erein or noL The prenting ol z permit tloes not presume to give aulhor ty�o viola�e or cancel <br /> lhe p���ision ol ary olher stale oi local law regulatinp conslm[lion or lhe pedormance ol con5imcliort Thai I am authoritetl by�he owne�of lhis,�roGe��y <br /> lo pedorm the worV.for�54ich appl ca�ion is made antl I compty wilh the State C/qniractors Law 7P�27 RCW and 296200 WAC <br /> ('rTf'�� 1 1 �� 'Z��\ /�Y" ('� "1 /��^[;��� <br /> OwnedAulhorizedAgentSianature Date � (Revi:ed7/201f) <br />