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� <br /> PERMIT APPLICATION <br /> BUILDINGIMECHANICALIPLUMBINGISIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett,W A 98201 -425-257-8810—FAX 425-257-8857—wwv✓.everetlwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITEADDRESS: PROPERTYTA%11 PERMIT� <br /> , � -U <br /> �J`111 ��„'.,,,.�������� T.v, , r1•. , ��, � htiDo�o )(� � 0 � <br /> I ? <br /> LEGAL lor new wnsduclion: Shoe PlaVsubdivision`l�G Q+�-" � �(� �"� ��<<'�0� �= (attach wpy of lorg legal descnption) <br /> OWNER �� ��1��^_ �1V�ii.��il�\i,_�lfS l_L � Phone�E-mail ��"��? - �L���� '`l�fi�'L� <br /> naa�ess 2'�I l� •�C ��• Si f�v� c��r�siaieiva ;�1 All U'JdCi 6J � t(4'� Z-'�7 L <br /> CONTRACTOR "� I � 1 Ill'( ���i ���1 (�i;ns4. u,� L 81 Lic.# HZ(i I��oC�'r31 n �"y <br /> Address <br /> ��l )� '�� � J�I�}I� �"���I� C�F"j�"� Z PhonalEmall rTlt�' ll (�(,Ili����� '�4�C�l��i�, <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT �.`I` ,�.� �i���y)��I <br /> lY 1q <br /> PhonelE+nail ��>� (� � � �"�" — �%r7 �4'. <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Ezisting Use ot Building ��%' �'t��� i� ��111 i� HEAT SOURCE: <br /> �� <br /> Proposed Use of Building t11 ��� ��`� (' Gas ' Eiecino Other <br /> Buiidingtype: �Singlefamily _Duptex_Townhouse _Multi-Family _Commertial <br /> Type of project: �New _Addition _Remodel _Repair_T.I._Sign_Sprinkler_Demolition_Change of Use <br /> Destriplion Of Work(eddilional space provided on tha 6ack): !,� ��- = I 7CJ g <br /> ^.I. <br /> �1 V 1��� �V ��i !:1'�� U <br /> 9aru�� = �tz� <br /> Have you started working wilhout a permit7 _YES �NO <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLiCAT10N <br /> TypeolProJect: �� New_Addn _,Alleratlon_Repair TypeoiProJect: �New_Addn _Alteratlon_Repalr <br /> SM1owNum6er�A)olRxfures ShowNumber(%f o/fiirtures <br /> �i A/C—airhandlin uNts �-, � Tnilet <br /> Forcedairs stems "-i BathWb <br /> � Gas pipin - � Lavalo (wash basin) <br /> \ Water healer tl � Sh�w�r <br /> � Gas fireplace Kilr,hen sink 8 disposal <br /> Gas ran e 1 Dishwasher <br /> � Clolhes d er 1 � Cicthes washer <br /> � Ranqe hood — � � �D��� <br /> � Exhausl fan L� � S�n4(servicelbadmo elc. <br /> r i � Heat pum '� Back9ow prevenler <br /> (; Unilheater � Urinal <br /> ��, � Boiler '1 � Drinkin Fountain <br /> ' Refri erelion Il Floordrain <br /> � Woodstove V '� Grease trap <br /> Ductin �� ' Roofdrains <br /> (�; Other U �'� Medical Gas <br /> SPRINKLER/ SUPPRESSION SYSTEM �; % Otner. <br /> `;� Number of Heads � � Other. <br /> I hereby certify Ihat I have read and examined this appliwtion and know the same lo be irue and cortecL All provisions of la�+s and ortlinances goveming <br /> this type of work v.ill be compiied wilh whelher specified herein or nol.The granling of a pertnit does not presume to give authonry to violale a cancel <br /> the provision of any ather state or local law regulating consWtlion or the pedormance ol consWclion.That I am aulhonzed by tha owner ot this property <br /> to pedorm lhe work lor wfiich applicaticn is made aM I tomply vAth the State Lonlradors law 1827 RCW and 296.200 WAC <br /> ;`�� I � ,� I �I�z �r� <br /> O�+marlAulHbrized Agant S�gnature Date (Revised 1/2017) <br /> � + fin <br /> l <br />