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� <br />PERMIT <br />� <br />APPLICATION <br />BUILDING/MECHANICALIPLUMBINGISIGN/SPRINKLERIDEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 Cedar St, [verett, WA 98201 - 425-257-6810 - FAX 425-257-8857 -- wv�v+ everettwa.o�g <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />4DDRESS: �?�•i� �J�U�V,'� A I� PROVERTYTA%p PERIJ�I, {!^�'O�� <br />�� r �\ I� i ��'1�� <br />loi ncw cor, iroclmn Shotl <br />BUILDING PERNlIT APPLICATION <br />E.istrng Use ol Dwldmg <br />ot tJo __ (aitaJi copy of lon9 icgal aescnpLon) <br />(/�(� Ciry/5tate/Lip Y/`��Y.iL� w' � <br />LSIL�c # G'�VGi�� �G t U <br />�, �� PhonelEmii � Zr <br />CUNTACT FOR PERMIT <br />Phone/E�mTil vl (� I�i� �� lni I <br />CONTRACTP ICE OF WORK !%� <br />H[!�T <br />Proposed Use of �udding � �as_A_ ciecmc �irer__ _ <br />Building type �S�ng'e Family _ Duplea _Townhocse _ Mulli�Family _ Commerc�al <br />Type of pro�ecl _ New _ AddiUon _ Remodcl _ Repav __ T I__ S:gn _Sprinkler _DemolA�on _ Change of Use <br />Descnption ol Work (adCdicnai space pr�mdetl on tAe eack) <br />Have you start� o� without a p_� YES �NO <br />MECHANICAL PERMIT APPLICATION <br />Typo of Pro�ecl: _New __Addn _Allcralion _,Repair <br />Show Num6er (pJ o! /ixtures <br />NC — air handhng unds <br />�� Forced a�r svstems <br />healcr <br />Unil hcater <br />� Olher <br />SPRINKLER / SU <br />Number of Ileads <br />SYSTEM- <br />PLUMBING PERMIT APPLICATION <br />ol ProjecP ___New _AAdn _Alteration _Rcoalr <br />Show Numbcr (uJ o! firtures <br />S; � <br />Kdchen vnh 8 � <br />Dishwasher <br />Clolhes washer <br />Watcr healcr <br />Sink (scrvicelb[ <br />Backflow prevc� <br />Urmal <br />Unnking Founla <br />f laor drain <br />Grease trap <br />Rool drains <br />Medical Gas <br />otner. <br />I hereby crNfy Ihal I have read anA examinetl Inis apU�ication and know Ihe same lo be Ime and conecl All pmvisions ol lavrs and o�dinances govemin9 <br />Ihrs type ol woik �viq�e compned vn!h whethei sper.ded lie�eu� ar nol The granimq o� a pennd does nol piesume l0 9ivr, au�honty lo vio�ate ur cancel <br />the prov�sion ol anroiher siale or iocai iaw aling conSWclion or Oie pedortnance ol wnslmction Thal I am aW�oriied hy Ihe owner ol Ihis piopeity <br />� pedorm Ihe �M� ich applic3lion is made n ty wil� Ihe Slaie ConliJ[�ors Law 10 77 RCW antl 296 200 WAC <br />OwnedAu�h� rizeU Ag�if Signa�ur \ � �»�e�I�� (Revisnd 2/1017) <br />� <br />