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PERMlT APPLICAI"10�1 <br /> BUILDING/MECHANICALIPLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 -425-257-8810— FAX 425-257-8857—www,everetttva.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM —1 g��/ <br /> S ITE ADDRESS: PROPf R7Y TAX H RMIT# <br /> �' � � � r�' �� l > > -- �� 3��I <br /> LEGAL(or new conslruction: Short Plat/subdivision Lo!No._ (a�tar,h copy of long legal description) <br /> OWNER J� � �-e V' � Phone/E-mail Z � Q - /z s' <br /> Address �-- �� �f ti f (� (,� CitylStatc/Zip t'v��C �� g�z�� <br /> CONTRACTOR L&I Lia# <br /> Address PhonelEmail <br /> TENANT BUSINESS NP.ME CONTAC7 FOR PERMIT <br /> Phone/E-mail <br /> BUILDlNG PERMIT APPLICATIUN coNTRAcr PRICE oF WORK <br /> Existing Use af 8uilding HEAT SOURCE: <br /> Propoced Use of Building Gas Electric Other <br /> Building type: _Single Family _Duplex_Townhouse _Multi-Family _Commercial <br /> Type of pro�ect _New _Addition _Remodel _Re�air_T.I._Sign_Sprinkler__Demolition Change c f Use <br /> Desc��riotion o(Work(ady�tional space provided on fhe back): <br /> /Sc'�c':'.� ,-� �v i�;� 5�'��� f c�.,����v -�-.: �.(-�' <br /> � w�r'!C <br /> Have you started working wi(hout a permit7 _YES _NO <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT Appi.ICATION <br /> Type of Project: _New_Addn Alteration_Repair Type of ProJocL• Now Addn AlLeration_Rop�ir <br /> Show Numbcr(#J o/lixtures Show N�mber(il)o/Iixtures <br /> � A/C-air handling w;its I Toilet <br /> � Forced air systems � Ba�htub <br /> Gas piping <br /> I N/a'er heatar I Lavatory(v�asn basin) <br /> I Gas fireplace Shovder <br /> t Kitchen sink&disposal <br /> � Gas range I Dishr�asher <br /> � Clothes dryer � <br />� � Range hood _ � Clothes���asher <br /> I Water heater <br />� � Exhaust fan I Smk(service/bar/mep.�etc.) _ <br /> � Heat pump <br /> � Unit heater � Backflo�v preventer <br /> Boiler � Urinal <br />�� � ReGigeration � Drinking Fountain <br /> I Woodstove � Floordrain <br /> � Ducting � Grease lrao <br /> � Other � Roof drains _ <br /> Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM --� Other: <br /> � Number of Heads I Other. <br /> I hereby ceit;fy Ihat I have read and examined Uiis applicalion antl kno�v Ihe same to be�rue and correcl.Ail provisior.s of laws and ordinances governing <br /> Inis lype ol vrork will be complied with whether specifed herein or not. fho granfiny of a permit does not presume�o give aulhoiily lo violate or cancel <br /> Ihe provision of any o�her s�ate or local law regulaling cons(rucfion or Ihe pe�formance of consimclion."fhat I am aNhorized o;Ihe owner of ihis propeny <br /> to prform IhewoiK(or�vhich ap�tion is made and I compty wilh Ihe S�ate Coniractors Law 1827 RCW and 296200�'JA� <br />� � �., .�/Y�����'.'L-� ������I <br /> Ownor/9utb6rizc AgnntSignaWro Date <br /> ' �;! (Fevised Z/1071J <br />�' --___ ___ — <br /> � <br />