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( l <br /> PERMIT APPLICATION <br /> BUILDING/MECHANICAUPLUMBINGISIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett,WA 98201 -425-257-8810—FA?C 425257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM!AM TO 4 PM G �O?j— D <br /> SREADDRESS: 'rJ�'II� ��(Ik,��N� EJQIQ�� �nl R MO►ERT'TAt(� PE � <br /> o b U 3a O <br /> LECKraoe�,cona�uuo�: snoa�avwca�w9�oo��E 11e.�.–o�o-�("_ �wrb.� h�ua�co�yorbrqby.ias.u+qb�� <br /> �+ER JJo�s ��,�es�� �n1s �� ����� a5 � �8�9 �y <br /> aaa�a�� 110 �0 = Si N v,1 CitylSlale2iP 5���WJ��I, W A qA,3�1 <br /> CONTRACTOR � �. -i i 1 � ��� . \StYVC�h�1n I,LL L&I Lic.# G� �t D��-� <br /> �deross ( �l� �'=� ��� I�E C vcU7i ft �/Sl'� �- Pnone�man <br /> NANT U INESS NAME ONTAC � � q11��1 /'n h� I�( I I <br /> i � l.C` <br /> PhonelE+nail � ' �-r� ' <br /> sU1LDING PERMIT APPLICATION CONTRACT PRICE OF WORK 10 0 D <br /> Existlng Use of Building�� C�IIi" GI� HEAT SOURCE: <br /> Proposed Use oi Building ��� � Gas FJecMc o�l,er <br /> Building rypa: �Single Family _Duplez_Townhouse _Multi•Family _Commercial <br /> Typa of pro�ecl: `{�,New _Addilion _Remodel _Repair__T.I._Sign_Sprinkler_Dertalitbn_Change ot Use <br /> Descriptbn Of Work/addifional spxe proviAed on fhe beck): � = I�7 CC` <br /> builc� 11,;��J SI"�' s�`� ����Qts = 4-�� <br /> Heva you startad worklnp wllhout a permlt7 YES �NO <br /> MECHANICAL PERMIT APPLICATION PLUMSING PERMIT APPLICATION <br /> Typ�otProJ�ct: ,�jNew_Addn _Altaratlon_R�pal� Typ�dProJwi: �w_Addn _Alhrallon_R�pair <br /> Slrow Num6sr W flYfuns Show NunMr d flxhw�� <br /> I A/C–airhandli uNts I Toilet Y <br /> I Porced air s stems Bathtub <br /> I Gas i i Lavato wash basin <br /> � Water heater l Shower <br /> 1 I Gas fire lace I Kitchen sink&dis sal <br /> I Gas ra e I Dishwasher <br /> Clothes d er o I Clothes washer <br /> \ Ra� e hood Water healer <br /> � Ezhaust fan I Sink servicelbar/mo etc. <br /> C I Heat um Backllow eventer <br /> 0 I Unit heater I Urinal <br /> ) I Boiler I Ddnki Founfain <br /> I Refri eratioc Floor drain <br /> p I Woodstove Grease tra <br /> I Ducti � Rootdrains <br /> U I Other � Medlcai Gas <br /> SPRINKLER I SUPPRESSION SYSTEM � I other: <br /> � Number of Heads U � Other. <br /> I hereby ceNfy thal I have read aM euamined this applKalian aM know ihe sama lo be We and cortect.All p�ovisbns of ia�+s and ordinances qaveming <br /> this type of work will be complied vrith wfie(her specified harein or noL The grenling o(a permit does not presume to gWe aWM41y to viokte or ceneel <br /> the provision of any other slale or loeal law regulating construttion or the peAortnance of cons Wtlion.That I em aulhorized by the oMner of ihis property <br /> perform the Mork(or wfiich application Is made and I comply with lhe State Contrectors law 18.27 RCW and 296.200 WAC <br /> 3 �3 �L <br /> e utho zedApant5lgnature te (Revlsed7/Y0f7) <br /> ( � <br /> a <br />