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( <br /> PERM�T APFLICATION <br /> BUILDING/MECHANICAUPLUMBING/SIGN/SPRINKLER/DEMOLITIO.V <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett,WA 98201 -425-257-8810—FAX 425-257-8857—www.everettwa.or� <br /> APPLICATION9 ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITEADDRESS• PROVEaivTnxa P MI7 <br /> r ' ✓ �� h� 98"l01 � D' ^02 � 0 -o° <br /> . ��7 ._ � , <br /> LEGAL lor naw wnslrvctlon: Short PleVsubtlivlelon Lot Nocar c6latlach wpy ol lonp leyBl de�ulpllon)5' <br /> OWNER � Phone/E�mail� 5- -yi33 <br /> Adtlross � CIIylStele2lp � �� <br /> CONTRACTOR �1' L& ILIc.N �_ <br /> Address PhonelEmall <br /> TENANT BUSINESS NAME CONTACT FOR PER 17 �'.�}�or �,y,� <br /> "'�„iv "� <br /> PhonelE-meil �i� � y� a <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use oi Building ) HEAT SOURCE: <br /> ProposedUseolBuildin6 �"�_ � - � ✓�f� Gea Ehcmc Other <br /> Building type: �Single Family _Duplex_ ownhouse _Mulli-Family _Commercial <br /> Typa ol pro�ect: �New _Addition _Remodel _Repair_T.I._Sign Sprinkler Demolition_Change of Use <br /> DescriplionotWork�eddrtionalapecapmvidadonthebeck�: ���r-�''nu`-�/��� �S) � �im,l�(- f'��/�YG, <br /> �ci��n� I�v��.� �r t� de„�pl;�y�d., � at�a�h�d l��.s fva� �'m�s <br /> Have you darted working wilhout a permlt7 _YES �NO /��' ��n Ki rK S <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type o}Pro�o�t: �Naw_Atldn _Alteratlon_Rapalr Typa ol ProJect: New_Addn _Altsntlon_Rep�lr <br /> Show Number(M)ol/7xturoa Sftow Numbsr(NJ olllxfun� <br /> A/C-air handlin units Toilet � <br /> Forced air s alems 1 Bathtub � <br /> Gas i in Lavato (wash basin �i <br /> Water heeter O Shower <br /> Gas � -5 Kitchen sink 8 dis osal <br /> Gas - Dishwasher <br /> Clolheyd er Clotheswaeher <br /> Ran e hood Water heater <br /> Exhausl fan ., �; Sink servicelbar/mo letc. <br /> Heat um � ij' ' , .� 1 � Beckflow revenler <br /> Unil heater � � ' Urinal <br /> Boiler ' � Drinkin Fountain <br /> Refri eration Floor drain <br /> Woodstove Grease lre <br /> Ductin Roof drains <br /> Other Medical Gaa <br /> SPRINKLER I SUPPRE8810N SYSTEM � Otner: 011 ElI� <br /> Nwnber c`Heads Olher: <br /> 1 hereby cetlily Ihat I have read end axemined�hle applicatlon and know�he seme to be Ime aM conecL PII provislann nl lews eM oMinenca�poveminq <br /> this type al work will be complied wilh whether specllled hereln or not Tha prontlip of a permll dues not preeums lo plve wl�odly to vlolale or uncel <br /> Il.n provislon ol any o�hei slale or local lew reguletlnp consiruction or Ihe peAonnence al cans�nictlon.Thal I em euthorized 6y t�e ownur ol ihle proper�y <br /> lo pedo��he work lor whic�eppliw�lon Is mede and 1 comp�y wilh Ihe Sinle Conlrocton Lew 18 27 RCW and 198.200 WAC <br /> �� �� �l�l�� � � <br /> Own�rlAuthorizadApent ipnaturs Dale (Revised7/2011) �( �i <br />