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( � <br /> PERMIT APP'iICATION <br /> BUILDINGIMECHANICAUPLUMBINGISIGN/SPRINKLER/DEMOLITION <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!AM TO 4 PM �"��`�� <br /> SITEADDRESS: G- PROYERTYTAI(M P IT� <br /> :..J AI G\ fl�',Y''{- _ <br /> LEOAL lor new wnetnxtion: ShoA PlaVeubdivlslon Lul No._ (atl�eh wpy of lorq bpsl doferlplion) <br /> OWNER (C Y16 PhonelE•mell ( ?S Z58- G <br /> ddme� s Dr• ciry�sutdzin ( � � 2 � <br /> CONTRACTOR 1� L 6 I Lic.N <br /> Odraee j � ' GL.y �JL�Y�� PhonelEm�ll � ls ZS — 3 <br /> PhonelE•m�ll <br /> SUILDINO rERM1T ArrLICATION CONTRACT PRICE OF WORK <br /> Existing Uee of Bullding HEAT SOURCE: <br /> Proposed Uee of Bulldinp Oa� Ebnrk Oiher <br /> Building type: _Single Femily _Duplex_Townhouea _Multi-Femlly _Commerclal <br /> Typa ol projad: _New _Addilion _Remodal _Repalr_T.I._Sign_Sprinkler_Demolitlon_Chanpe of Use <br /> peectlp(tlOn 01 WOdt(edddlonel apaee piovlded on fAa beckJ: n <br /> I�(,r�l��� W A.'�{,Y' L '��✓� GL �V " 1 es'�V���tG� h'L(,�v � /Wl'��. . <br /> Have you�hrtad working without�permil7 _YES _NO <br /> MlCNANICAL PERMIT A��LICATION �LUM�INO rlRMIT ArrLICATION <br /> Typ�ofProNel: _!Mw_Addn _AR�wtlon_R�p�ir Typ�o/ProJal: _Nrw_�ddn _/JbrNlon_IGy�ir <br /> 3Aow Numbo �)ol/Irtuns 9Aow NumM� o/Bxnna <br /> A/C-air handlin unite Toilel <br /> Farced eir s ateme Bathlub <br /> Gas i in Levato wseh baain <br /> Water heater Shower <br /> Gas fire lace Kitchen alnk 6 dii owl <br /> Gas ran e Dithwasher <br /> Cbthas d er Clothes waalror <br /> Ran e haod Weter heater <br /> Exhausllan Sink servicelber/mo etc. <br /> Heat um Backfluw revealer <br /> Unil healar Urinal <br /> Boiler Drinkin Fountein <br /> Refri eretion Floor drain <br /> Woodstove Groaae tra <br /> Ductin Itool drains <br /> Olh�r Medical Gas <br /> sPRINKLER/ sUPPRl8s10N SYSTEM other: <br /> Number ol Heads Othar: <br /> I herehy certily Ihat I heve reed and ezemined Ihle applicetlon end know I�e eama to be true end coned.All provl�lone ol lavn and oNinonce�povemirp <br /> this lypa ol work wlll be complled wllh whelher spei911ed hereln or not.The prantlnp ol e pertnit doae not pre�ume lo plve aut�orlty lo violNe or cancal <br /> the provlelon ol any otl�ar elale or local law regulal6ig conelrucllon or Ihe peAormance ot con�lrudlon.Thet I em eulhorized�y IM ownsr ol lhle propa�ly <br /> la parlor Ihe work lolN��hic eppllGall ie ede and I comply wilh Ihe State Con�nclon Lew 18.27 RCW end Y98.Y00 WAC <br /> r 7 �� <br /> �� �. � \4 / . �...� � .�./� �/ �� <br /> �1 <br /> Pw �dAulhor�dApenlS��7�tun I ��4J���1�� ala (Mvbsd?QOf1J <br /> C ��f 25 3Z �-�f31 <br />