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srTE <br />� � <br />�EI�MI`T APP�.IC,AT�4N <br />BUILD�N�/M�CI-�A�IICAL/pLUI111BfNG/SIGN/�P�INKI��R/DEIVIOLITION <br />CITY OF EVERETT P�RMIT SERVICES <br />3200 Cedar St., Everett, WA 98201 425-257-8810 FAX �25,257-8857 www.everetkwa.org <br />s�rr rax a <br />RMI'f # <br />B �- �S' R;� _. / � , � <br />for naw conetructfon: Snort Plat/subdivlslon Lot Nv, (attaeh copy of long legal cioscription) <br />n <br />�"'-" � � Phone/E-maif <br />� Cltyl5k5te/Zip — .�-� � <br />�r <br />� Ownar _ pwner's Aqent Contrector � Contractor�s qqent � Tonant �muni p�OvltlO 010ttnr o��p�sent frorq 1�9 WA'10� tO do work ln ih? epaCe) <br />BUI�,pING P�RMIT APPLtCAT10�1 <br />Stato LIC, <br />;T FOR PERMIT <br />g��``�``�`�-I <br />CONTRACT PRICE OF WORK <br />Existing Use of Bullding <br />Proposed Use of Building <br />Building {yp�: � Single Family �, Duplex �Townhouse _ Multi-Famlly � Commercial <br />e of ro ect: New Additian Remadel Ra f T I <br />Cit Bus, Lic, � <br />� ( �A�c <br />c <br />>��� a� <br />�T 50URCE; <br />Elactric Other <br />a r SI n S rinkler uomplltl011 chan e of Use <br />pESCRIPTION OF WORK (ada;tloaal spAca pro��ded on tna beok) ; `�,5� � <br />(�e��C 2 C�r�> ��'� � uc�.ce ��- <br />Wt� ��c�,P �c-�e� <br />M�CHANICAI. I��R2RII�MT �A�'�l�I�qTNON PI.UM�ING PERM�T APPt,MCATION <br />Type of ProJvcC `New Addn Alkerr�kion,_Repair Type oP Pro)ect: „New�Adtln ,_Alteration,_R�pair <br />Shew Nurnbor # of Rxtures Show Number vl ffxturea <br />A/C -- air handlina units � T..��... <br />Water heater <br />Gas flreolaco <br />SPRI�IKLER / SU <br />� hood <br />ist fan <br />wmp <br />eater <br />eration <br />stcve <br />ig <br />PPRESSION <br />sr of Heads <br />Kitchen sink & <br />Dishwashor <br />Clothes washe <br />water heator <br />Slnk (servica/t <br />Backflow prevc <br />Urinal <br />Drinklnq Fount <br />Ffoor drain <br />Graase trap <br />Raof drains <br />Medlcal Gas <br />Othor: <br />I hemby eenlfy Ihnt I have reed ena ex9minetl Ihis applicetton nnd know !be e�mv to be trve end corc�ct. All provl��ona oi lawa entl ordtn�nces govamfnp thla type of work wn( be comp� <br />wfth wnothRr aDecltlee het4ln or not. The prantlnp of a pertnit aoes nok preeume ko glvr. �uthorlty to vlolntn ar cancel the provl2fon ot eny nlher atAte or local Inw YnpulOtinp constructton <br />authofl�ntl by t owner aflhi� propr.rty fa perform thn Work for wnlch epDlfceUon ts mntln qnd I comply wlth the 3tate Contrnctors Law �8.27 RCW nnd 298.200A WnC. <br />_ ___ �� o�`l � ( � <br />rized Ayont Signature Ontc (Rev;sed 42a75) <br />