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PERMIT APPLICATivN <br /> BUILDINGIMECHANICALIPLUMBING/SIGN,'SPRINKLER/DEMOLITI�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar SL, Everett, WA 98201 425-257-8810 FAX 425-257-8857 vrriw.everl th�+ .g{g!O UJ <br /> L <br /> SITE ADDRE'.i5: PROPERT!7A%d PERMIT d <br /> ��� �=���c � .r.�� a7- �yyo r �-�r_. <br /> LEGAL Icr new construcborc. Short PlaVsubdrvision Lot No.__ (allach cepy ol long legal descnp6or� <br /> OWNER PhonelE�mail <br /> .address Cily/State/Lp <br /> APPLICANT:_Owner _Ovmer'sAgent �Conlraelor _Con�racloisA9enl Tenant�e�,�Fviceea�ene�c�ccn+eri:,ommocnr•u�oe..�c�i.i;ronv�cU <br /> CONI RACTOR �M ni�� State Lic. N f��G��sCj�T/"�.-_Cily Bus. Lic # <br /> l�dd�ess C/U��l ��r/eY i�(/L J42�l/�l3� L PhonelEmail �"' �Q',�$7� C-�G�� <br /> TENANT BUSINESS NAME CONTACT FOF�ERMIT /f //`v <br /> � �� � � /�jr.� f-hc�ld ,�/� <br /> � S PhonelE�mail �J�// <br /> BUILDIN PERMIT APPLICATION CONTRACT PRICE OF WORK �O[70 <br /> Ezisting Use of 8uilding HEAT SOURCE'. <br /> Proposed Use of E3ullding Gas_ Electnc_ Other_ <br /> Builtlin9 type' _Single Family _Duplex_Townhouse _t�lulti-family _Commercial <br /> Type of pro�eci New Addition _fi�Remodel __Repair TJ. _Sign�Spnnkler___Cemoli6on_Change of Use <br /> DESCRIPTION OF WORK l�rcemn�l sc:�ceF��v�eevo�!n^ha.�.l <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type ol Projecl: __New_Addn _Alleration_Repair Typo ol Pro�eel: _Ifew_Addn _Altera�lon_Ropair <br /> Show Nurtrocr(dJ al lixmms Show Numbcr�#)o/lixf ures <br /> NG-air handhng umts � Todet <br /> � Forced alr systems I Oathtub <br /> � Gas piping i Lavatory(wash bas�n) <br /> I Wa�er heater I Shower <br /> I Gas(ireplace I Kitcl�en sink 8 disposal <br /> Gas range I Dishr:asher <br /> � Clolhes dryer � Clolhes washer <br /> Range hood � Waier healer <br /> Gzhausl lan Sink(service/badmop/etc) <br /> f leat pump � E3ack0ow preventer <br /> Unit heater � Urinal <br /> � �oiler i Dnnking Fountain <br /> � Refrigeration � Flaardrain <br /> Woodstove Grease trap <br /> Ducting I Roof drains <br /> Other Pdedical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM Olher: <br /> Number of Heads I Other: <br /> I herc0�ceihfy Ihat I�uve read and eaamined I�is upp�icalion and know I��e 5ame lo Ce Irue and corteq.All provisions cl lan5 o�d cr0iwnces 9oveming Ihis Iype ot wo�k will be com,^lie� <br /> w�:�whClhe' p cdieC nerein ot net T�e granhng cl o pertnil Coes o01 presumc lo grve dulnority Io violate or WnCPI lne plovision ol any clher s�a:c or ICW I law reguldtmg wnslNttion <br /> That I am a 1� i:ed by Ihc owner of Inis pmpeny lo pedorm me woA lor wTlcli aCp6wlion is made antl 1 wmpty wilh Ihe Sea1e Comra:tors Ls+v 1821 RCW anE 295 2�OA Vl4C <br /> �-- a- <br /> O ned ulhorized AycN Siynaluw Dafe (Rem5etl3R013) <br />