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I <br /> PERMIT APPLICATION <br /> BUIL�INGIMECHANICALIPLUMBINGISIGNISPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett,WA 98201 -425-257-8810—FAX 425-257-8657—www.everethva.or <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM Ia <br /> SITEA qR SS: PROFENiYTA%N PERI�LTj1}. �/I�Z�/ <br /> l.{��{ �2�, C � Cle�.0 1J� C.lt� <br /> LEGAL for new construqlon: Short P1aV6ub0ivision Lot No.__ (altach copy ol bnp lepal descriptlon) <br /> OWNER k al �in �'1 PhonefE-mall L12.� �Z —� 3 <br /> Addressf'3� II SL= - f:e:N' ►+l 8?l�' ciryis�aie�z�v �vc c�{� I,JA �1Y2A <br /> CONTRACTOR L 8 I Lic.# <br /> AOOress Phone/Emall <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT (y�Si n s'�s Y� ,�` 'U'''M <br /> . PhonelE•mall NZS�3�o-l�3 7 HZ,t-4Z --6 <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Ezisting Use of Building F'� HE4T SOURCE: <br /> Proposed Usa of Buflding S F� Gas eiearie Omer_ <br /> Building type: �Sfngle Family _Duplex_Townhouse _Mu�ti•Family _Commertial <br /> Typeofprojed: _New _Addition _Remodel _Repair_T.I._Sign_Sprir.kler_Demolilion_Change otUse <br /> DesGiplion of Wofk(etldlHonal space ploNded on fhe backJ: <br /> I�[ (n�! <br /> Have you started working without a permil7 _YES �NO <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> TypeofProJect: _New_Addn _Alteratlon_Repalr TypaolProJect: _New_Adtln _Alteretlon_Repalr <br /> Show Number(M1 0/Axtures Show Number(NJ o/flatures <br /> � A/C—airhandlingunils Toilet <br /> Forced air s stems Bathlub <br /> Gas i ino Lavato wash basin <br /> � Water heater Shower <br /> � Gas fireplace Kilchen sink 8 dis osal <br /> Gas ran o Dishwasher <br /> � C�othes dr er Clothes washer <br /> Ran e hood Water heater <br /> � Exhaust fan Sink servicePoadma /etc. <br /> Heat um Backflow reventar <br /> Unit healer � Urinal <br /> Boiier Drinkin Fountain <br /> Refri eration Floor drain <br /> � Woodslove Grease trao <br /> � Ductin Roof drains <br /> Other Medical Gas <br /> SPRINKLER/SUPPRESSION SYSTEM I otner: <br /> NumberofHeads � Other: <br /> I hereby cetlify�hat 1 have read and examineE Ihis appliwtlon and know lhe same to be We and wrrxt.All pmvisions ol lawa and ordinances goveminp <br /> ihis type ol work will be complied vnth whether specifed herein or not.The granting of a permil dces nol presume to give author0y to violate or wncel <br /> the provision ot any olher state or local law repWalinp construction or the peAortnance ol consWc!lon.That I am authorired by t�e owner ol ihia property <br /> to peAorm t�e work for which applicallon 16 made and I wmpry wilh ihe State ContradoB Law 18.27 RCW anC 298.20o WAC <br /> 7�.j1EY��':.j� ���1`� �2 —�2 —� <br /> OwnerlAuthodzed Agenl Slgnalure Date (Revised 7/70f f) <br />