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PERMIT APPLICATlON <br /> ; QUILDINGIMECHANICAL�PLUMBINGISIGN/SPRINKLERIDEMOLITIQN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 -425-257-8810- FAX 425-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM T04 PM I 2 — _� � <br /> SITEA�D�SS: ! PROPERN�AXN C ,�,J P �TI�I ��O <br /> 5" � � , <br /> LEGAL lor nwi construction�. Short PlaUsubdivision Lot No._ (atta:h copy of Icng legal description) <br /> OWNER � � l'ISC. �y Phone/Email .y- J�����'Z� <br /> Address 2 � ,f(� �L�(� . W ' CitylState/Zip GVbLGYr G(J/�� 9��.�03 <br /> CONTRACTOR I�/- ":} NI'(E P �ii .-. d- HI - L81Lic.k D 'iy'.%�i-�< <l2 <br /> Address � •. 1� �f �7i1,{2 v�. G1�• LYN/`� �U� ��G�3� PhonelEmail Z -rj-775�����'� <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT��4,� ���[�Lf FF <br /> PnonelE-mail `�Z�i �r7-C.� o� <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK ��.���5 3� <br /> Existing Use of Building HEAT SOURCE: <br /> Pmposed Use of 8uilding Gas Electric_ Other_ <br /> Buildingrype: �SingleFamily _Duplex_Townhouse _Multi-Famiry _Commerual <br /> Typeofprojecl: _,New /�Addition _Remodel _Repair_T.I._Sign_Sp�inkler,_Demolition_Change ofUse <br /> DescriplionofWork(additio�alspaceprovidedonihe6ock): ��Q��G �X(5�7n1(�-- �S ������ ��� <br /> n��w C—ns Tcar�n�ncE �� s�-m� t�cA-nor� , �c N�% E�s OrG'iN�. <br /> I Have you started working without a permit? _YES �NO <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> 7ypv of ProjecC _New_Addn _Alteration_Repair Type of ProJecl: _New_Addn _Alteration_Repair <br /> Show Number(�)o/!ix(ures Show Number(#)o/fixturns <br /> � A/C-airhandlingunits � Toilet <br /> � Foreed air systems � Bathtub <br /> � Gas piping � Lavatory(wash bzsin) <br /> , � Water healer � Shower <br /> Gas fireplace I Kitchen sink 8 disposal <br /> � Gas range I Dishv�asher <br /> � Clothes dryer � Clothes washer <br /> � Range hood � Water heater <br />` � Sink(service/barlmop/etc.) <br /> � Exhaust fan � Backtlo:v prevenler <br /> � Heat pump <br /> i � Unit healer � Urinal <br /> � Boiler � Drinking Fountain <br /> ' � Refrigeration I G ea erlra <br /> � Woodstove � P <br /> � Ducting � Roof drains <br /> � Other I PAedical Gas <br /> SPRINKLER / .�iUPPRESSION SYSTEM Other: <br /> INumber of Heads I Other: <br /> I hereby ceAify that I have rzatl and examined this appllration and kncvr the same to 6e true and wrrect AI provisions of Ia�.Hs and ordinances governing <br /> this type of work will be cemplied with wimether specified herein or not Tne grantinq of a permit does not presume to give authority to violate or cancel <br /> the provision ol any other state or local law regulaling wnstmction or the pertormance of construclion,That I am authorized by the ovmer of this pmperty <br /> to pzdorm lhe vrork for which application is made and I r.omply•rvith the State Co L::ctors Law 1027 RCW and 296 200 WAC <br /> �� ,� ��2� � /� <br /> Owner� lhorized Agent Sign re <br /> ate (Revised 2/2071) <br />