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� �. r�l��J � - _ c�- g��3 � a <br /> � ���� � - � < <� <br /> �`�':.,� � k 2�tz,`` , ; :��PERMIT APPLICATION <br /> r �i ANICAL/PLUMBING/SIGN/SPRINKL�RIDEMALITION <br /> �8.�1�.�4���-� <br /> _ CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Eve�ett, WA 98201'-425-25'i-b810—FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM S �I F7—�2 <br /> SIT�DRESS: `v �� PROPERTYTAXM � PERMI�TF, ' �l <br /> LS./ V <br /> LEGAL(or new conslruclian: ShoA PlaVsubdivislon Lot No._ (attach copy o(long Iegal desuiption) <br /> OWNER PhonelE•mall <br /> Adtlress Q,�C �—, '7�i CitylSlatelZip �5� � 1,� <br /> CONTRACTOR Gr.iS L&I Lic.# �4!<m b.�`' i 0 7 <br /> �.5.9 •af�3 •333� l�i� <br /> Adtlress `f. q9�`.S7 TA�GmA 9f�'I�O Phone/Email � ��t �•,�.0 � .Cj <br /> TENANT BUSINEuS NAME :ONTACT FOR PERMIT <br /> �N�„� G,,�FEr e?S3•S'73d3rZII <br /> Q�� '�/(�u0/l PhonelE-maii lu /G.aLS • <br /> BUILDING PERMIT APPLICATION cON7w�CT PRICE oF WORK /. ,rfSd <br /> Existing Use of Building f TXiiL HEAT SOURCE: <br /> Proposed Use of Building .ef-r.4JL �lJ�4d2 .�AI��S Gas_ Eiectric other <br /> Building type: _Single Family _Duplex_Townhouse _Mulli-Family ,,�' Commercial <br /> Type of proJecl: _New _AdBition _,Remodel _Repair_T.I.�Sign_Sprinkler_Demolition_Change of Use <br /> Cescription of Work(addifional spece provided on the back): �N 3TR�– ��f� C/��N'��� �'L�t.2 <br /> LJAcL s�G.s�+ ��-�A-r.'tiw�C} �� QFc �/ C�uo2�• <br /> Have you startad working without a pertnit9 _YES �NO <br /> MECHANICAL PERMIT APPL�IGGTION PLUMBING PERMIT APPLf.�-�A't:ON <br /> TypeofProJect: _New_Addn _Altenllon,_Repalr lypeofProJect: _New_Addn _Allaratlon^Rep�lr <br /> Show Number(N)01//xtures Show Number(M)01/lxturea <br /> A/C–air handlin unils Toilet <br /> Forced air sVstems Bathtub <br /> Gas i in Lavator (wash basin <br /> Water heater Shower <br /> Gas fire Iace Kilchen sink&dis osal <br /> Gas ran e Dishwasher <br /> Clothes d er Clothes washer <br /> Ran e hood Water heater <br /> Exhaust fan Sink service/6ar/mo letc. <br /> Heal um Backflow reventer <br /> Unit healer Urinal <br /> Boiler Drinkin Fountain <br /> Refri eralion Floordrain <br /> Woodstove Grease ira <br /> DuMin Roof drains <br /> Other Medical Gas <br /> SPRINKLER/ SUPPRESSION SYSTEM Other. <br /> Number of Heads Other: <br /> I hereby ceAly lhat 1 have read and examined this epplicatlon and know the same lo Ue true and wrcect.Ail provisions ot laws and ortlinenxs goveming <br /> thls type otwoAc will 6e comp�ied with whether specified herein or not.The prenting of a permit does not presume lo Bive aulhority lo violate or cancel <br /> the provislon of any other stale or lowl law re8ulaliag construction or Ihe peAormanrs ot consWdlon.That I am aulhorized by the owner ol this propeAy <br /> lo pertorm the work for which application Is made and I comply with the Stale Contractore Law 1827 RCW and 296.200 WAC �I� <br /> ��J�,u ��/� .5io •i� l <br /> OwnedAulhorize gen[ f natur Date (RevisedT/2011) <br />