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( ' <br /> PERMIT APPLICATION <br /> BUILDINGIM�CHANiCAL1PLUMBINGISIGNlSPRINKLERIDEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett,WA 98201 -42�-257-8810—FAX 425-257-8857—www•evereriwa.org <br /> APPLICATIONS ARE ACCEPTED FROM E AM TO 4 PM <br /> SITE ADDRESS:.. G L PROPERN TAIf N P M�T� D _ A//_ <br /> (U <br /> LEGAL for new construction: ShoA PlaVsubdivisfon Lot No._ (atlech wpy ollonp legal Oescription) <br /> OWNER � � � Phone�E-mall <br /> AM1dre:s CHy/StelelZip <br /> CONTRACTOR L&I Lic.# <br /> Address 3 v G � �(� ^�- � d PhonelEmeil <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT �4 s,�� �� p/p��J <br /> V ,l•C`—' U PhonelE-mail U�' �T�r m`���'Cvw� <br /> BUILDING PERMIT APPLICATION _ coNTRncT Paice oF woRK <br /> HEAT SOURCE: <br /> Existing Use of Building <br /> Gas Ekcidc Other <br /> Proposed Use a(Building <br /> Building type: _Single Famiiy _Duplez_Townhouse _Mul�i-Family ,_,Commerciai <br /> Typeofproject: _New _Addition _Remodel _Repair_T.I._Sign_Sprinkler_Demoiition=ha�t�se <br /> Descripli0n of Work(additionel space provided on Ihe back): '�h ST�i I� G <br /> 3t� � Qt4M qnd� V <br /> 3� � ��= � �a �� <br /> Have you started working without a pertnit7 _YES •�NO <br /> MECHANICAL PERMiT APPLICATION PLUMBING PERMIT APPLICATION <br /> Typa ot Project: _New_AOdn _Akantlon_Repair Typ�ot ProJxl: SM1ow NumMr an ofllxfunsGon_Repalr <br /> Show Number(MJ o//i:+un� Toile� <br /> 1 A/C-air handling u�its Bathtub <br /> � Farced air systems <br /> Gas i in Laveto wash basin) <br /> Waler heater Shower <br /> Gas freplace Kitchen sink 8 dis osal <br /> Gas ran e Dishwasher <br /> Clothes d er Clothes wesher <br /> Ran e hood Water heater <br /> � Exhaust(an Sink service/bar/mo /elc. <br /> Heat pum <br /> BackFlow reventer <br /> Unit healer Urinel <br /> Boiler Drinkin Fountein <br /> Refri eration Floordrain <br /> VVoodstove Grease tra <br /> Ductin Roof drains <br /> Other Medical Gas <br /> SPRINKLER 1 SUPPRE8SION SYSTEM Other: <br /> Number of Heads Other. <br /> I hereby certily lhat I have read and examineC Ihis application and know the seme to be Irue arM corted.All provlsions of lawe end ordinencea qoveinirp <br /> this type of wo�k vnll be wmplieA with whether specifed herein or not.Tha Brenling oi a permit Ooes nol presume to give aWhority lo violale or cancel <br /> the provision of eny other state or local:aw regulaling consiruc!ion or Ihe performence o1 conslrucllon.That I am aulhofized 6y ihe�wnei a�lhis properry <br /> to pertorm Ihe work tor which application is made and I comply with ihe State Contractors Lew 1B27 RCW end 296.200 WAC <br /> �7� Ci� ��- 00 /lF��/ (ReviseC?l1011) <br /> OwnerlAuthodzad Age Ign�ture Date � <br /> � <br />