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l <br /> PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBINGISIGNISPRINKLER/D'cMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett,WA 98201 -425-257-8810—FAX 425-257-8857—www.everettwa.ory <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM T01 PM <br /> flOPE TY E <br /> os e c o tto � 8- E✓�c�7T t8o9�z.do4��9 0 0 :- -015 <br /> LEGAL Por�w construdion. Shatl Plat/sub�ivlslnn__ _ __ _�ol No._ (altach wpy ol lonp lepel desulptlunl <br /> OWNER BO��J OLfl �1C.�� L�► Phona.'Email 5— �1�' �.3 3 <br /> naaresa�. O. B�X ?-bOg aryisiaierzir C�ai�O W 19 � <br /> CONTRACTOR I`4EL L 8 I Lic M �LGO C Z O N I— <br /> \� AddmesZ%u—.� 45�Wp1—�+������"� Phone/Cmail zob-�!3o-`1�4u �WL'�r <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT � <br /> 5 H�A2 Q HA�►�►�c y Phone/[mail f L� �'�' ����i��� s�� <br /> BUILDINGPERMITAPPUCATION CONTRACTPRICEOFWORK�3$ ppCi.'= IvYi.-�_ �oi�. <br /> Existing Use of Buildmg <br /> �,yF� 2� K„� HEATSOURCE� 1�`' �y '(`- I°�' <br /> ProposedUseofBuildinp WOR-k AR6A �Oe phAQM1�Cy GasX [ieanc_ olhe„ <br /> Bwlding type. _Single Family _DupleK Townhouse Multi-Famlly x Commercial <br /> Type of proJecl: _Naw _Additlon _Remodal _Repalr�T.I._Slgn_Bprinklor_Demolillon_Chenge of Uee <br /> [�sc,�ip6on of Work(edddronei spece provrdnd on tho enckl. <br /> E�(Oft+aO EXZST'fldl� PWA¢MAL`I 'b-�U !ltr'LJ SPHCtf '�e LR2�jd�Z <br /> 1�2K f�Q6A- ND Q�R�sI. �¢or� N�W SPFlL6- <br /> Have you etaAod working wilhout a pormll7 _YES�NO <br /> MFCHANICAL PERMIT APPLICATION PLUMBIN(i PERMOT APPLICATION <br /> Type ol Pro�ec1: _Now_Addn �Altantlon_Ropa�r Typ�ol Pro�acF. _Nwi_Addn x AlNntbe_Repdr <br /> Show Number(MJ o/fl+fune Show Number(M)o!Rrfune <br /> NC–air handhn uni�s lotlet <br /> Forced a�r s•ctems F3ethtub <br /> Gns i in l.nvelor (washbasin <br /> Watnr heater Shower <br /> Ges fire Ince Kltchen sink 8 dis osal � <br /> Gas ran e Dishwasher � <br /> Clolhes dr r Clothec wTsher � - <br /> Ran e hood � Water heater <br /> F::ha�st 1an Sink servicelbarimo felc. <br /> Hcal um Backflow reventer � <br /> Und healef <br /> Unnal ` <br /> Poilnr Drmkin Fountain � <br /> Rnln e�alion Floordram <br /> Woodstove Grense Irap <br /> CJucLn ' Itool Arams <br /> Ulher MMical Gas <br /> SPRI KLER I SUPPRESSION SYSTEM otner___ ____ <br /> NumUer nl VMatls <br /> I Imrnl�y cerVly Mal I have rna0 and eyamir�A this npphr.�iion nn�l knuw Iha same lo bn t�ue end coirecl All provisiona ol lewa eM ardlne�ices goveming <br /> Ih�s lype nt work mU be compLe�wih whelher spedfletl herrtin ai iml.7 ho grpnting of e pormit does nol presumo lo givo aulhonty to violale m cancel <br /> Um piovision ol any olher slete or local law reguiabnp mnsbuction m Iho paAormance ol construclion Thel I�m euthodted�y the ovmer r1IMs property <br /> lo pednmi Uic xuik�u�whidi eOYlicatiun is maAe and I comply wiU�Ihe Slale Conlractorn law 18?7 NCW anE 296200 WAC <br /> �(�� oZ- \S-2o►I <br /> OwnerlAuthorlxod Agon�SipnaWre L/ale !Rnv�sed i7?010) <br /> ��L <br />