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- ( �. <br /> PERMIT APPLICATION <br /> BUILDING/MECHANICAUPLUMBINGISIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES �-a'�-- !/ <br /> 3200 Cedar St., Everett WA 98201 -425-257-8810—FAX 425-257-8857—www.everettw g 7 <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 1 PM �ID/ �� <br /> SITE AODR SS' PROPER7Y TA%p PER <br /> � u3�� Ih;��C.4i 2D S� �- <br /> LEGAL/or new construclion S�ort PlaVsuDtlivisicn�S3YIZ��Q Z��ot No._ (atlacli coDY of long legal tlescnplion) <br /> OWNER V�L.��L /��) Pnone�E-mail 4�-) ��c'�.�7� nn1UIC"'NSLbk�K'170.0 <br /> tltlress LV� U l�� I'C�� NL. CirylState2iD � ��,"UV�= l'�/�` ��"�7 <br /> CONTRACTOR � ��1�C1� �1 C�r�� I�C- L S I Lic.lt S � 1 I 4 �lL7 <br /> ddress c- ��� ��/C:Lr '„ ���� Phme/Email �� 1��- �y� � <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT �� f`3 ]�1 <br /> ��i�`�i l� /� F�l(k��L Cct�AvJ - ��xV� <br /> "Z�}�1 CJ{� SC1 L�1�CY_] P�one/E-mail 1(V P <br /> BUILDING PERMIT APPLICATION CONTRACT GRICE OF WORK �c�t�t� -- _ <br /> Existing Use of BuilUfng_ HEAT SOURCE: <br /> Proposed Use of 8uildmg _ Gas_ Electnc_ Other_ <br /> Building rype: _Single Famity _Duplex_Townhouse _Multi-Family _Commercial <br /> Type of prqect: _New _Addition _Remodel _Repair_T.I._Sign_Sprinkler_Demolition_Chanqc of Use <br /> D25Gription cf Work(atltlitional space provitled on the back);`e,''`f/, "/ � (� l , � <br /> ���� � �� ���~�� � �' y <br /> _ <br /> , <br /> Have you staRetl wo mg without a permit7 _VES _NO <br /> MEGHANICAL ' ERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Prqect: _New_Atl. _A��ention_Repair Type of Project: _New_AAtln _Allera6on_Repair <br /> SMw Number ryy oI fixiurea S�ow NumOer(M)o/flxlures <br /> A/C--air handlin units 1 Toilet <br /> Fcrced air systems BathWb <br /> Gas piping � Lavatory(wash basin) <br /> Water heater ' Shower <br /> � Gas fireplace Kdchen sink&disposal <br /> Gas range � Dishwasher <br /> Clothes dryer Clothes washer <br /> Range hood � I Water heater <br /> Exhaust fan , Sink(servicelbar/mop/etc.) <br /> Heat pump Backflow preventer <br /> � Ur�C neater Urinal <br /> Boiler Drinkin Fountain <br /> � Retrigeration Floor drain <br /> Woodstove Grease trep <br /> Ducting I Roof drain5 <br /> Other � Mediwl Gas <br /> INKLER SUPPRESSION SYSTEM a«� <br /> � <br /> Number of Heads Z I Olher: <br /> I hereEy cediry that I have reaE an0 examinetl this aOPlication anE know t�e same to be true and correcl.All provisions o(laws anC orAinances goveming <br /> Inis rype ot nrork vnll�e com0���with vv�emer specified herein or no;.The 9ranting of a permit tl.oes not presume to give authonry to violate or cancel <br /> the provrsion of any other state or Ic.;al law regulabng construction or the perlormance of wnstmctiort T�at I am authorizetl by t�e avrier of this property <br /> to peAorm the rk fp which ap0�������s made antl I wmply wit��he SWte Coniractws Law te27 RCW and 298100 WAC <br /> zl�-A ���'� �Ii'��-(�; ��.1 S <br /> UwneAAUNotl ed Agent Signahre Date (Revisetl 1/2077) <br />