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� <br />� <br />PERMIT APP�iGATION <br />BUILDING/MECHANICALIPLUMBfNG/SIG�V/SPRINKLER/D�MOLITION <br />CITY O� EVERETT PERMlT SERVICES <br />3200 Cedar St., Everekt, 1NA 98201 425-257-gg10 FAX 425-257_g$57 yvwyv,everettw�.org <br />SlTE ADDRESS: <br />3�J � PR O��Ax� PERMIT <br />3o t 12- � <br />LEGqL tor new constructlon: SY�ort PlaUsubdivision <br />^ � ot No, (attach copy of lony l�gal de£cription) <br />� <br />PLICANT: � Ownar <br />ONTRACTOR <br />� r L 1Phana/�-�f12if y��. Qj a� . <br />� Ciiy/Stata/Zip <br />Owner'Sl�qen[ ContraCtor COntractor'g /� bnt <br />—M � �_, �T�F�nafl l{rc�u5( �rpy�de a IrzKcr or can8enl &om the owner to Uo work In Ihc apdC6) <br />�'�-Q-'� StatA Llc. # �� Cit BUS. Lic. # b�� p( � <br />� � I�i Q g Phone/Em@il `�� .a � � • � Q� <br />�oNTACT FOR PERMI'C p,� m� ,� ,�,y�,y`�,y� <br />BUILDING PERMIT APPLICATI�N <br />�� . � <br />aa.� • .. <br />•' �-� �i • <br />Exisfing Use of Buliding � <br />H�qT SOUF:CE� <br />F'roposad Use of B rldincy Ges Electr�c o�h <br />Buifding fype: �inylg Faniily � Duplex `Tow��house _ Multl-Family _ Carrmercial <br />T e of ro'ect: New Addition Ren�ode! Repalr T.I. Si�n S ri�lklel' pemolition Chanqe <br />DESCRlPTIpN OF WOCtK (eddillonal spece p�ovrded o the back) : ` <br />� Yl � l 1 J g� Oo� �� v c� v C.-1-1-�s S l�l.t�--� �u � <br />MECH4NICAL PERMIT APPLICATION <br />Type of ProjEct: _NCW _Addn �AlteraklOtl ,�Repair <br />Show Number # ot ffxftlres <br />A/C — air handli�� Ur�its <br />Forced �ir svstems <br />Cas P�.� <br />Water hester <br />Gas firc lace <br />�as range <br />ClotMaS dryer <br />Rai�ge hood <br />�xhausE fan <br />Heat pump <br />Unit heater <br />Boiler <br />SPRINKLEIi / SUPPR�SSION SYSTEM <br />Number of I;ead9 <br />PLUMBIN(i pERMIT APPLICAT��N <br />Of Project: _N�W �Addn _Alteraflpn �,Rspair <br />Show Number of Fxfures <br />Toiket <br />Bathtub <br />Lavator wash basin <br />Shower <br />Kitchen sink 8� ciis osal <br />Dishwas��er <br />Clothes washer <br />-� water he�ter � <br />Sink service,'bar/mo /etc. <br />Backflvw revgnter <br />Urinal <br />Drinkin Founp�in <br />Floor drain <br />Grgase tra <br />Roof drair�s <br />Medical Gas <br />� Other: <br />_ OthAr: <br />I here�y ccr�ify thet ! have rcad end exsmined thi� epp�i��lon �ntl know thg same to ba true and corrsct. All provisiona o�laws 9ntl oWinanccs go�srning �his tyDe otwork wlll be comp <br />h whethar epeCifisd hsreln or nvf. Tha grantlny of a parmit does not preeume to gfvs aulhority to vlolate or canGe� t�c Drov�ion of any other siete or local law reg�lafing construct;on <br />T�a ! am e Whorited ey �he own � of I�is pr�perty tu perPorm th� wo�c fo� wh •h app caPion Is mada and I comply w�En Ihe St�ts Contractors Lew 1 B27 RC W and 29S.20oA WAC. <br />' � ��a s , ���a� <br />�tCClAuthonzed Ayenf Siflnature pate � (Revi$ed 9/2014) <br />