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PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLERIDEMOLITION <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 TO 4 PM - �� —I Z <br /> PROPERN7AX tt PERMITK <br /> SIT AD�RESS: ^ ._ � Z <br /> .. (1C� .�rVi >/I� `� <br /> LEGALforne�vconstmction: ShortPlat/su6drvision _ <br /> Lot No._ (altach copy ol long legal description) <br /> OWNER �n�-'? ��"7 c� -�L• Fhone/E�mail y�.;_5 7'�'7/ � ��D <br /> r <br /> Address � C�l L) �lV�C'v l� CitY/5tate/Zip L. � �/�/ / W . <br /> � /� <br /> CONTRACTOR - c , .:, l� /��G �!•,'�•, &I Lic.# /'�.D �� - �- I �' �` <br /> �� —i ^ p �^?,,, i��lTeo vi?� 5'�-'a7 Phene/Email � OG ? �G 3y4�L <br /> 4ddress.��G"-J S O p �'- / o„v(� <br /> CONTACT FOR P�RMIT �r /� <br /> TENANTBUSINESSNAME ��G,� 7 •�p -��N� /� . /- 1' -7 <br /> I �7 f' I l✓!:G � C �=•�✓�/- 1P�Sf.r.� PhcnelE�moil .) P � W�Nv C �Si✓, Ld''� t[��T� 1 <br /> BUILDINGPERMITAPPLlCAT10N CONTftACTPRICEOFWORK ��-�=r'-- 8� 9 - <br /> w /% cl �F� ��I HEATSGURCE: MeCh= ��OU� <br /> Exisling Use of Building � <br /> ProposedUseofBuilding Si�MC Gas__ Eleclnc_ Olher__ <br /> Building type: _Single Family _Duplex_Townhouse _MWti-Family _Commercial . <br /> Typeofpro;ecC _New _Addition �Remodel __Repair_T.I._Sign_Sprinkler_Demolitio__Change ofUse `��� <br /> Descriplion oNdork(addifional space provided�fhe 6�c:d� �r t���� `S����;7� � _ 'e�✓nf)I"� -+'e'`� ' J, n c `. <br /> � n�r2,�r,,r, ,..� � :. � ,� � , e:-.� �% l�lla�,rs /'6�..els <br /> i i1" �[�+C)S � 1 <br /> � j l�r:��l� I),-^ ��v •�-�-Tr �.7 ij:� ��i,..G� 5 /!�✓L/L.� L 5 �S,Zi' <br /> Have you started work(ng without a permil7 _YES _NO 5✓��!•"�� e'� �-R <br /> MECFIANICAL PERMIT APPLICATION PLUMBING P— ERM�T APPLICATION <br /> TypeofProJecL• _New_Addn _AlMrallon_Repair TypeofProjecL• 5"w°Nurn6er(N)ol/lxtures�lon_Repalr <br /> ShowNum6a(q)alfiufures � Toile� <br /> � A/C-airhandlingunits � Batntub <br /> � Forced air syslems ' <br /> � Gas piping Lavatory(wash basin) <br /> � Water heater � Shower <br /> � Gas fireplace I Kitchen sink&disposal <br /> Gas range � Dish�vasher <br /> Clothesdryer � Clotheswasher <br />-� � � Nlater hea�er <br /> Ranye hood � Sink(servicelbadmop/etcJ <br /> � Exhaust fan � Backflow preventer <br /> Heat pump � Urinal <br /> Unit heater �rinking Foun�ain <br /> Boiler � Floor drain <br /> �-+ � Re(rigeralion � Grease trap <br /> � Woodslovz � Roof drains <br /> � Ducling Mzdical Gas <br /> � Other <br /> SPRINKLER I SUPPRESSION SYSTEM � other. <br /> �i �� y � Olher: <br /> �"U�--�'I Number ot Heads <br /> I hereby certiy�hat I have reatl and examined ihis applicalion and knorv the sama to 6e Irue and correcL All pmvisions ot tavr and crCinances 9oveming <br /> uiis tyFe of work will ba complietl vnth whether specified herein or not.The grantin9 of a Fermit does not presume to give au�hon�y lo viola�e ar cancel <br /> Um p�ovision ol any olher state or local�a�v regulaiing wns�ructicn or the pedormance of cons:ruction.That I am authorized by ihe owner al�his property <br /> to Hedorm the vrwk�pr v.�hi[npppliw�ionis made and I comply with the Stalo C tractcrs Law 1827 RCVJ and 298100 WAC <br /> / / � <br /> '�' �.�'1i�� L� <br /> OwnedAu�hyrizptl Agenl Signature � <br /> �ate (Revisetl7/2�111 <br /> / j � <br /> � <br />