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PERMIT APPLICATION <br /> BUILDINGIMECHANICALIPLUMBINGISIGNISPRINKLERIDEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 - 425-257-8810 — FAX 425-257-8857 —www.everettwa.org Q <br /> APPLICATIONS ARE ACCEPTED FROM B AM TO 4 PM O " �rJ � l( <br /> SIT ADDRE55: PROPENTYTAXN PERMIT — <br /> 3 5� <br /> LEGAL lor new conslmclion� Shorl PlaVsu6drvision___ __�ot No,__ (Attach copy ol long legal descriplicn) <br /> L� � Phone/Em�d y Z„) � `-' �� <br /> OWNER D c' � <br /> Atldress� 7i� -� CIty15tale2ip � � <br /> CONTRACTOR L 8 I Lic N <br /> Address PhonelEmail <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> PhonNF.�mad <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORN_ <br /> [xisting Use of Building HEAT SOURCE. <br /> Proposed Use o�l/E3udding NC�I1i� _ Gns Elecmc Otner <br /> Building lype�. C Single Family _Duplea_Townhouse _Mul�rfamily _Commercial <br /> Type of projecl�. _New _Addition _Remodel �Repair_TJ._Sign_Sprinkler_Demol�bon_Change of Use <br /> Description oj Work jnddmonai sp.�c pmmded o�fhe�nck). <br /> r� wi rc, s�i��. �- �;,u �_ /c c) ���'� ��;,i� � <br /> , / <br /> Have you atarted working without a permit7 .._YES _NO <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Typo oi Pro�oct: _Now_ Addn _Allarellon_Ropalr Typo ol ProJocl: _Now_Addn _Altoretlon_Repelr <br /> Show Number(M1 af lixlures Show Numbcr(N)of lixfurcs <br /> AIC -au handlm umts I Toilet <br /> � Forced air s stems � Hathtub <br /> Gas p�pin Lavator wash basin) <br /> Walcr heater Shower <br /> Knchen sink 8 dis osal <br /> Gas Ineplace pishwasher <br /> Gas ran e <br /> Clotl��es dr er Ctolhes washer <br /> Ran e hood Water heater <br /> Ezhausl fan Snk(serncelbarlmo ietc) <br /> Heal pump Backtlow preventer <br /> Uad healer Unnal <br /> 8oiler Drinkin Foun�ain <br /> I ReOigeration Roor dra�n <br /> Wocdstove Grea=e tra <br /> Duding Roof drams , <br /> Othe� _ Medical Gas , <br /> SPRINKLER / SUPPRESSION SYSTEM Other <br /> I Num6er of Heads Olher <br /> I heieby ceitdy Iha�I have iead enA e�ainineA this apphcelinn and know Ihe s:nne lu bo Ime end torrecl All provislons o�laws end ordinences gove�i���a <br /> tlus type ol wo�k will be cmnpl�ed wilh wheltier speciLeA here�m m�ul 1 hn gini�ting o�a Oermit does not presume lo Bive aulhonty lo vlolale or cnncel <br /> nw p�ovision ol any olher sixle o��ocal luw regulaling conet�ur,tlon ot Oie perlom+ance o�cons�mctlon ihat I em eulhunaed by ihe owner ol lhls property <br /> i��pe�bnn Ihe work lor which application is made end I comply wilh Ihe Slale Crn��rec�ers Lnw 1B 4T RCW 9nd 296 200 WAC <br /> � � ) . �l' /,si' ' /� <br /> Ownor/flu horimA Agenl Slgnnturo <br /> ate f Hnv�sed 7/<"0 t 1) <br />