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' � <br /> PERMIT APPLICATION <br /> BllILDINGIMECF�ANICALIPLUMBING/SIGNISPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett,WA 98201 -425-257-8810—FAX 425457-8857—www.everettwa.arg <br /> `�(1 i MPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS: PnoPEnTY7AX� PE ��R _ <br /> O L30 � <br /> LEGALIor�aewconsWcllon: ShortPlaVsubdivislon LoINo._ (ettechcopyollonglegaldescription) <br /> OWNER � PhoneiE•mail � I Z �� �?11N7h{� <br /> Adaress � FO{Z <br /> CitylS�a�eRip�l LYAIUIk La I ' �� <br /> CONTRACTOR IS L 8 I Lic.# <br /> Address PhonelEmail <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT L K/L A <br /> �/� CTtiAL"r{-1�Q�K�j PhonelE-mail '�j `]j�.7 'L�00 GQANMS ��w�� LN <br /> BUILDINGPERMITAPPLICATION coN7w4c7PRICEOFWORKf/o5aaoe.ao <br /> Exisling Use of Building �i'�SIKIALK�s HEAT SOURCE: <br /> ProposedUseofBuilding /� GLN.IiL �PN�'41LAp -rt��kaaY) Gas Elearic other <br /> 6uilding type: _Single Family _Duplez_Townhous� _Multi•Family �Commercial <br /> Type of project: _New _Addilion �Rert,odel _Repair,�T.I._Sign_Sprinkler_�emolition_Change of Use <br /> DeSCripli0nolWofk(addilionalspacoprovidedontho6ack): ��W ff�Y�a�LAL TII{�cKAS�YCLIN�G, �'U�51��� <br /> Ot= MTL sN� fi ���� Pk�.�n ncnJS, MBviF�ckTluxl /�HU I��x�riD�l a� M���AN/��L, <br /> 1'WMf3lAl(�, AhlO �LfcG'fi21litL SE�l1lLFfi 'F� GLI/�lrL USG• <br /> Have you started working withoul a permil7 _YES NO I <br /> MECHANICAL PERMIT APPLfCAT10N PLUMBING PERMIT APPLICATION <br /> Type ol Project: _New_Addn _Alterellon__Repalr Type o1 ProJect: _New_Addn _Altentlon_Repair <br /> Show Number(N)olllxtures Show Number(d of fltlures <br /> I A/C—airhandlin unils Toilel <br /> ! Forced air s s�ems Bathtub <br /> ' Gas pi in Lavato wash basin <br /> Waler healer Shower <br /> Gas Gre lace Kitchen sink 8 dis sal <br /> � Gas ran a Di�hwasher _ <br /> Clolhes d cr Clolhes washer <br /> Ran e hood Water heater <br /> � tzhaust fan Sink service/bar/mo letc. <br /> � Heal um Backtlow reventer <br /> Unil hr.aler Urinal <br /> 8oiler Drinkin Fountain <br /> Refri eralion I Floor drain <br /> Woodstove Grease tra <br /> Ductin Roof drains <br /> Olher Mediwl Gas <br /> SPRINKLER f StiPPRESSION SYSTEM other: <br /> � Numbcr ol Heads I Other: <br /> I hercby certily Ihal 1 havo read and examined�his applicalion end know lhe samn l0 6e Wa and wrted.All provisions ol laws and ordinances goveming <br /> lhis type ol work will be complied vrilh wfielher speciGed herein or noL The grenting ol a pertnil does not presume to 9ive aulhority�a violalo a cancel <br /> the provision o1 any olher stalo or local law regulaling construnion or lha perlortnance ol consWction.That I am authonzed by lhe oMner al this property <br /> to Oe�torm ihe work lor wfilch appllcation Is made end I complY wfth the State Cantraclors Law 18.27 RCW and 296.2D0 WAC <br /> �� �c,v�-, -22-1 � <br /> OwnerlAuthorizedAyant Ignature Dale (Revised7l2011) � <br /> \ � <br />