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PERMIT APPLI�ATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLERIDE�OLITION <br /> CITY OF EVERETT PERMIT SERVICES �a �a�� I� <br /> 3200 Cedar Sl., Everett, WA 98201 -425-257-8810—FAX 425-257-8857—wvr".=veretlwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITEADDRESS} /a ?i� � � PROPERNTAX# r�T' IZ'OG�Jj <br /> LEGAL for new conslmction: Shcrl Plat/subdivision _Lot No._ (attach copy of Irdg legal description) <br /> OWNER �//(- L �� PhonelE-mail <br /> �J C' CitylSta�e/Zip f ��` �'� �� 7" � <br /> Address /�� � ✓ - <br /> CONTRACTOR );/O G�� L&I Lic.# <br /> Address PhonelEmail <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> FhanelE�mail <br /> BUILDI�IG PERMIT APPLICATION coNTancTPRICEOFWORK <br /> HEATSOURCE: <br /> Existing Use of Building <br /> Pmposed Use of Building _ Gas_ Electric_ Uther__ <br /> Building lype: _Sin91e Family _Duplex_Townhouse _Multi-Family _Commercial <br /> Type of projed: New _Addition _Remodel _Repair_T.I._Sign_Sprinkier_Demolilion_Change of Use <br /> Desc�iption of Wo�k(addilionul spaqe provided on!he back): � �` �V�;�� <br /> J '� <br /> ��, .'W1,G 5�f'ru,�:/rr.tf� ��{,I � (�(JI OL i <br /> � � t� <br /> Have you staM1�work og without a permit7 _YES _NO <br /> MECFIANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type o(ProJecl: _New_Addn _,Alleration_Re�a�r Type of ProJecl: ,_New_Addn _Alteratlon_Repair <br /> Show Number(#)ol lixlures Show Number(N)ol lirtures <br /> � AIC—airhandiingunits I Toilet <br /> � Forced air systems I BathWb <br /> � Gas piping I Lavatory(wash basin) <br /> I Waler heafer I Shower <br /> � Gas fireplace � Kitchen sink 8 disposal <br /> � Gas range � Dishwasher <br /> � Clothes dryer I Clolhes washer <br /> � Range hood I Water heater <br /> � Exhaust fan I Sink(servicel6admopletc.) <br /> � Heat pump I Backflow preventer <br /> Unil healer I Urinal <br /> �oiler I Drinking Fountain <br /> � Refrigeration � Floor drain <br /> � � Woodslove � Grease lrap <br /> � Ducting Roof drains <br /> �� � Other � Medical Gas <br /> SPRINKLER I SUPPRESSION SYSTEM I Other: <br /> INumber of Heads I Other: <br /> ! I hereby wrldy th2t I have read and examinetl this applicalion and kno.v lhe same lo be ime and correci.All provisions of laws and ordinances goveming <br /> this lype of vmrk will be wmp�ied vnth whelher specifed herein or noL The granting ot a permit tloes not presume to give aulhority lo vio!ale or wncel � <br /> Ihe provision of any o�her s�ale'r local law regulating construction or Ihe pedorman[e o�consimction.Tha�I am aut�onI�d hy Ihe owner ol lhis properry � <br /> to peAorm ihe work lor which application is made and I compiy wilh the Slate oniractors Law 1827 ftCVJ ana 296.20p�lryAC � �j[ <br /> r��/ rJ'� <br /> y _> . \ 2 iv <br /> OvmedAuthoAzetl Agent Signat re � �ate „ )�11 (Revisetl 1/2017J <br /> V� <br /> J� <br />