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PERMIT APPLICATION <br /> BUILDING/MEC.HANICAL/PLUMBINGISIGNISPRINKLER/DEMOL1710N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett,WA 98201 -425•257-8810—FAX 425-257-8857—www.everetlw .org II <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 1 PM 2 <br /> �.V �� PROPEP.TYTA%N PERMIT� - Q <br /> SITE ADDRE53:,� r C h 5� ,� U (1 d w/ S P o <br /> pP� . <br /> LE6AL for new comtruaiorc Shoh PiaUu�:NiN�ion Lol No._ (atlach mp'y ol bn0 kYal OesctlFlWN <br /> OWNER � S S I N �' �S 1 N. E J{� L l G P�onrUE�mell <br /> tlCro.e f. C N F �� i t� $ �.:��01 �,�q oa4 CiyiStet�Z�p <br /> CONTRACTOR �-� i�'�' ' L 6 I Llc.N <br /> dar�u <br /> Plwne/Ema�l �'L( C R/���r�1 <br /> TENANT BUSINES9 NAME CONTACT FOR PERMIT <br /> ,.O.r. VA�•�� 411�� � PhonUE�ms���s�� 43i 9a 3�' � <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK � <br /> HEAT SOURCE� <br /> Ezisllnp Uee ol Buflding <br /> Ge� Electilc Other <br /> Proposed Usa ol BulMing <br /> Building lype: _Single Femily _Duplex_Townhouee _MuItl�Famity _Commerclal <br /> Type ol pro�act: _New _Addilion �,Remodel _Repelr_T.L_Sfpn_Spnnkler,_Oemolitlon_Change ot Uae <br /> DeSctiptlon ol Work feddifronel sp�ro provlde0 on(he bscN): <br /> � „'. � n�.I 6v A c IL l N [ o o L(i,� — �, f 7 i R-v � 0„6 U <br /> Heve you slerted working wlthoul e pe�mit7 _YES ✓NO <br /> MECNANICA� PERMIT APPLICATION PLUMSING PERMIT APPIICATION <br /> Typs ol ProJ�cl. _Nrw_Rddn _A��e�etlon_Nepelr Typ�ol ProJacl: _Naw�Addn _AlUntlon_R�pdr <br /> ShowNumDar MJof/l+turae ShowNumDar olflAun� <br /> NC-eirhandlin units Toile� <br /> Forced eir s stems I Belhlub <br /> Ges i in Leveto wesh besin <br /> � W�len c�eler Shower <br /> � Gas 6re lace Kitchan elnk 8 dir osal <br /> Gas ran a Diehwaeher <br /> Clolhesd er Clotheewasher <br /> Ren e hood Weter heatar <br /> Exhaust lan 31nk senicelbartmo /elc. <br /> Heal um Backllow reven�ar <br /> UNt healei Udnel <br /> Boiler Drinkln Foun�ein <br /> Relri eralion ✓ Floordreln <br /> Woodslove Groese Ira <br /> Ductin Rool dreine <br /> Other Medicel Gae <br /> SPRINKLER I SUPPRESSION SYSTEM otner: <br /> Number ot Head� Olher: <br /> I herebY cetldy thel I�ere renE anC rxamineC Ihii appliullon end knav Ihe ume to be true en0 carccl.All prcvitbn�ol lavn end ob�nsnces poveminq <br /> ��is lype ol work wdl be comphed w�ih whel�er epeafied herain o�not.The prentlnp ol e yrmA doe�nol Oreeume to piva eulhorilY�o vb�ete a ancN <br /> Ihe p�ovltion ol eny olhe�slale or local lew repulelirp contlrudlon or IM pertormence ol con�lmclion.Thel l em sut�orized W��e owoer of tMt qoperb <br /> lo peAarm Ue work ioi which efV���atian 4 mede end I compry xAh tM Slale Conlndon Law 1E 27 RCW end tYE.200 WAC <br /> 'l..—. /� �� � �d '/�i '�l <br /> `t'.. ' l// .�- � jJ-��Gl�^ (ReNfeC 7R01/) <br /> J[ <br /> Ownar/Aulhotlx d Apant 8�9^����° Dale <br /> 'l� <br />