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rERMIT APPLICATION <br /> BUILC�NGIMECHANICAL/PLUMBINGlSIGN/SPRfNKLER/DEMOLITIQN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 -425-257-8810—FAX 425-257-8857—www.everettwa.arg <br />� APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM /`J I` <br />� (� PROPERTY TAX p P M)IT 77 l <br /> G �'�S �C .Si E�tl�t—Y I- 1,v �� �C� Lc. I /�d � —L��r� <br /> LEGAL(or new conslruction: Shoit PlaVsubdivision lot No._ (atlach copy of long legal description) <br /> OWNER �� CNC��L�SN (.�`.=�'v�1 (��-l.Jt12/�L �,�CS PhonelE-mail � z S ` �(�`� '" �Is� <br /> Address � <br /> �CC' �C-�t Y�t�.lt�'� �ti� s �/C`� city;statelzip C—V;.�n�'� �U�4 I ��C' � <br /> CONTRACTOR (Zt�r��rr�,S I�LV'���v �C� L 8 I Lic. # ��-N�� r '�'`�y � �SC <br /> �ddress �"f Zz � �� �'�'��Z.� I�Ifa-iJ� SV�l�: �-�S I��U,I.P W� Phone/Email LS3 —�;�i��-�,C��'���� �Y�� (I(/< � <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> � ' 9 p <br /> �N N�'� ���� �� � I � ����1����ClJ L C1V��� Phone/E-mail G��� >> ' �C' � ��'���c�� <br /> BUILDING PERMITAPPUCATION CONTRACTPRICEOFWORK /Sod �' <br /> Existi�g Use of Building HEAT SOURCE: <br /> Proposed Use o(Building_ Gas� Eiedric_ O(her_ <br /> Budding lype: __Single Family _Duplex_Townhouse _Mulli-Family _Commercial }C . <br /> Type of project: _New _Addition _Remodel _Repair_T.'._Sl�n_Sprinkler_Demolition_Change of Use I <br /> DesCfiplion of Wo�k(addilional space provided on fhe back/: <br /> Have you started working without a permit? _YES u NO <br /> MECHANICAL PERMIT APPLICATIQN P:.UMBING PERMIT APPLICATION <br /> Typo ot ProJocl: _Now_Addn _Altcration_Ropair Typo of Projoct: _New_Addn �Altoration_Ropalr <br /> Show Nunrbcr(q)ol lix(ures Show Number(#)ol!lxmres <br /> NC—air handling unils � Toilet <br /> Forced air systems I 6athtub <br /> Gas piping I Lavatory(wash basin) <br /> Water heater � Shower <br /> Ges frepiace � Kitchen sink 8 disposal _ <br /> Gas range I Dishwasher <br /> Clolhes dryei � Ciothes washer <br /> Range hood � Water healer <br /> � Exhaust fan Sink (servic=_/badmoplelc.) <br /> � hleal pump � Backflow preventer <br /> Unit heater � Urinal <br /> � Boiier � Drinking Fountain <br /> Refrigeration Floor drain <br /> � Woodstove � Grease lrap <br /> Ductin9 Roof drains <br />� _ Other _ _ _ � Medical Gas <br /> SPRINKLER / SU.PPRE.ciSInIS�SYSTEM __ I Other _ <br /> Number ol Hcads <br /> I he:ehy certily Ihat I have read and examined ihis application and know�he same fa be Iruo and wrrecl.All provisions of lavrs and ordinances goveming <br /> Ihis�ype of work will be complied�.vith whelher speciliea herein or noL Tho granting ot a permil does not presume(o give authority lo violate or cancel <br /> Ihe provision of any other stale or local la�v regulalmg cons(ruclion or Ihe peAormance of conslmctior..7hat I zm aulhorizeU 6y the mvner o(Ihis property <br /> lo pedorm Ihe vmrk!or which application is made and I comply wilh the Slale Contrac�ors Law 1827 RCW and 29Fi100 WAC <br /> Owncr/Authorized Apent Siynaturo Da6� (�ev�sed t2.2010J <br /> I' <br />