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� � <br /> PERIVIIT APPLICATION <br /> BUILDINGIMECHANICALIPLUMBING/SIGNISPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES S �7—f y <br /> 3200 Cedar Sl., Evereti, WA 98201 425-257-8810 FAX 425-257-8857 ww�v everettwa.org <br /> SITE ADORESS: PNOP��^'�T��"---� .�PERMIT# <br /> l o f,���l�3 7`���-- ^ �I v F� <br /> LEGAL lor new con;ti�:Uon ShoA PlaUsubdrv„ion lot ho_ fattaeh eoDY ot Ieng leca�Ce;cnp9cn) <br /> OWNER ��/ � Fhone�E-ma�i <br /> Address � Crty/Sta1e�DD � <br /> APPLICANT: Owrer OwnerSAgent Contiactvr ConlraUor'SAgeni �enant�m�s�o�craeaien<ro�coose-.iaon+�,�en+.^.roac..o*�o�.��n1;.�.r� <br /> CONTRACTOR OWh State Lic # Gry 0us Dc # <br /> latlress Phonel[mad �10� ��4 � (�� T",^� <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT �JG Qt�y Pp A <br /> 'TO/3�GGo �� pl�pne'E mail (f\�(p � (�JQ � <br /> BUILDIPiG PERMIT APPLiCATION CONTRACT PRICE CF WORK <br /> [x�stmg Use of Bu�lding HEAT SOURCE <br /> Proposed Use of Budding Gas_ Eiear�c__ oiher_ <br /> Bu�lding type, _Single Family _Duplez_Townhouse _tdWtrFamdy _Commerual <br /> Type of pro�ecf. New AddAion Remodel Repair T I._Sign Spnnkler_Demolilion_Change of Use <br /> DESCRIPTION OF WORK(adart�onai spacA c�ov ded o�ire baca/: <br /> � wall s�yns <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> TypoofProject: _New_Addn _Alteration_Repair TypeolProjecl: _New_Adtln _Alieralion._Repair <br /> Show Num6er(a)ollixtures Show Number(q)ollirfures <br /> A/C —air handhng unAs � To�iet <br /> i Forced a�r systems Bathtub <br /> Gas piping I tavatory(wash basin) <br /> I Water heater I ShOwr.r <br /> Gas fireplace i K�lehen sink 8 disposai <br /> Gas rangc I Dishwasher <br /> � C�othes dryer i Cbthes washer <br /> � Range hood ' Water heater <br /> Gxhaust fan Sink(servwNLar/mop/etc) <br /> Hca�pUmp I l3ack0ow preventer <br /> Und heater Unnal <br /> ! [3o�ler Drinkmg Founlam <br /> I Relrigera6on � Iloor dram <br /> Wootlstove G�ease trap � <br /> Duchng Rool drains <br /> � Oth-�r—_ ,---- � tded�cal Gas <br /> SPRINKLER / SUPPRESSION SYSTEM other <br /> Numbcr o!Heads I Olher. <br /> I nereby cen�ty i�al I�ave reaa antl exam�nea iha aDP�,�abon anE know ine same to be true and cared.Au prors�ons ol iaws antl artlmanres govemmq this ty�e ol work w�,A be compi,e0 <br /> wnh vihe�ner speulie!here:n or not Tne g�eni�ng ol a Oerm�Ooes nol p�esume io gwe anAor�ty to v�oiaie or cencel�ho p�ouis�on ol any olher s�ale or iowl iaw iegutating canstrudron <br /> That i am authonzeE�y me owner cl lnis pro��eny to pertorm t�e work im w�'¢h appimahon is matle an01 complY wM�t�e SlBle Convatlers Law 1B 27 RCW an0 796 700A WAC. <br /> O� �r�� �� /11�-� �l��l,r�( ` � v <br /> /Aulhonzed Agc l Signaturo Da e (Rcwsed Y70�3) <br />