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(� � <br /> PFRMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING1SIl�N/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMET SERVICES �3�� .�— <br /> 3200 Cedar St., Everett,WA 98201 -425-257-8810—FAX 425-257-8857—www.everettw orgn � <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM o{p — <br /> SI7EADDRESS: IA �� _ J_ ���� PROVERTYTAXp P IT� _OO <br /> �7/ <br /> LEGAL for new conslnMbn: Shwl P�aVsubdivislon Lo!No._ (atlaU�rnpy ol bng kgal dowiption) <br /> OWNER ►i(�(�,Y.aIJ �]CA�UO PlronrlE.mail <br /> ddmss CitylStale/Zip <br /> CONTRACTOR �y TC'J L&I Lic.# <br /> ddrcss N.3av , r ' f. S G��TIz�� �I(J�7 Phonel[maJ e.cxy C�/7-y 7Co <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT �/,, <br /> PhonelGmall �� �/�I'�J�.� oZOG)8�'7—��G� <br /> BUILDING PERMIT APPLICATION CONiRACT PRiCE oF WORK - <br /> [xisling Use of Building H[AT SOURCE: <br /> Proposed Use ot Buiidfnq Gas Electnc Othcr <br /> Buildingtype: _SingleFamily _Duplez_Townhouso _Multi-Family _Commercial <br /> Type of proJect: _New _Addilfon _Remodel _Repair_T.1._Sign_Sprinkler_Demotilian_Change of Use <br /> Oescriptfon ot Work(additionel space providedon Uw becl�: i ,�$J I�.�}y�/�/(,V�f�s <br /> � � .��r�7�� �,(��rl�`�{��."�� � �t-��� � �;� <br /> Have you staRed working without a permitT _YES _NO <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> TypeofProJecL• _New_Addn _Altcralion_Rcpair TypoolProJak _Now_Addn _Atteratlon_Repalr <br /> Shaw Number(/)of/lalures Sl�ow Number(1)o!Ilrfurcs <br /> NC—air handling units Toilet <br /> Forcedairs stems [3athtub <br /> Gas i In Lavato w�sh basin) <br /> � Water healer Shower <br /> Gas freplace Kitchen sink 8 dis osal <br /> Gas ran e Dishwasher <br /> Clolhesd er Clotlieswasher <br /> Ran e hood Waler heater <br /> Exhaust(an Sink(servicelbar/mo letc.) <br /> Heat pump Oackflow revente� <br /> Unil heater Urinal <br /> Boiler Drinkin Founlain <br /> Refri eration Floordrain <br /> Woodslove Grease tra <br /> Duc�in � Roofdrains <br /> Other Medical Gas <br /> SPRINKLER/SUPIPRESSION SYSTEM Other. <br /> Number of Heads I Other: <br /> I hereGy ceNy�hal 1 have�ead and examined this applicatbn and know Iho sa.ne l0 6e Inw and wrrecL NI provisions ol laws aiM oNina�es yovemirrp <br /> Ihis typo ot xrork vnll be mm�lied with whettier specifed herein or no1.7hv granl Irg of a permil docs no1 presumo lo give authonly to vioiate a rancel <br /> lhe pmvisbn of eny other state or Iocai la reguiating mnslruclion or lha pedortnanw ol consWUion.That I am authorized lry lhe wmero(this properry <br /> to perfgrm lhe work fa wfilch anpl'tceti Is mnde and I eompy with iha 51 to nlractors Law te.27 RCW and 298.200 WAC <br /> .� � � <br /> -� � � (Z, <br /> O nerlAutho z tl nt ure lu (Fevised 1R011J <br />