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rERMIT APPLICATION <br /> BUILDINGIMECHANICAUPLUMBINGlSIGN/SPRINKLERIDEMOLITION <br /> CITY ��F EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA f iS201 -425-257-8810-FAX 425-2�1-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTEU FROM 8 AM TO�PM � � a.��.�/ <br /> 2(otS .�— CA � Jc. - u S - <br /> LEOAL lor naw conetn�cllon: Shorl PleViubdMelon lol No._ (ellech copy ol lon9 bpsl de�cripllon) <br /> OWNER Phonert�meil <br /> Addrcs� CltylStale2lp <br /> CONTRACTOR "y���.,� l&I Lic.p �c1�r'� 9QJ( YY� <br /> Addreee yU 4 l'�•�Hc�A'• �n� ~ J �oy PhonelEmall 253- $o _ oyo <br /> TE ANT USINE A E CONTACTFO PE I�T ,�,�� ?jb-L..�O-Y�I�l2 <br /> ��jllF. ��tOG.�}�Of�� V�inv� PhonelE-mall llL �'T7"��5-yJ''� p(a�� � (/1�� 1��-• l�l <br /> OUILDING PERMIT APPLICATION CON7RACT PRICE OF WCRK 3,�,� � <br /> Exieting Usa ot Bulldinp �5:ia lic� S11'�o HEAT SOURCE: <br /> -T-- <br /> Proposed Uee of Buildfng_ 5l��� 6ae Ekdnc oiMr <br /> Bullding lypa: _Single Famlly _Duplex__Townhouae _Mulli•Femily �Commercial <br /> Type of proJecl: _New _Additlon _Remodel _Rapelr_T.1._Sign_8prinklar_Demolltion_Ch�nps ol U�s <br /> DBSCrIp�n oI Work(eddifionel epece proviqeO on rha DackJ: <br /> �r"iT�eM1,.yT'`.., c,� ri UFlys clf- KAcI��,.ib ?� 51�'L�� 3ry <.:: ���5(�i+ti�+G <br /> �cy�,Pn+��T,.ti.���. PAtn.c� �Za�K�,Jo `-'r'��. <br /> Have you staAad working without a pertnil7 _YE9 _NO <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type ol Pro�sct: _Naw_Addn _Altsntlon_Rep�ir Type oi PraJect: _N�w_Addn _Altantlon_R�p�ir <br /> Show Numbe� MJ ollixtuns Show Number N ol flxfunt <br /> A/C—eir handlin unita Toilet <br /> Forced air s atems Bethtub <br /> Gas i in Leyalo weah besin <br /> Waler healer Shower <br /> Ges fire lace Kitchen aink 8 dis osel <br /> Gas ran e Dishwasher <br /> Clothes d er Clo�hea washer <br /> Ran e hood N'ater heatar <br /> Exhausl lan Sink eervicelbar/mo letc <br /> Heat um Oeckllow reventer <br /> Unit healer Urinal <br /> Boiler Drinkin FouNain <br /> Relri eralion Floordrain <br /> Woodstove Greese tre <br /> Ductin Rool drains <br /> Other Madical Gas <br /> SPRINKLER / SUPPRE8810N SYSTEM _ O�her <br /> Number ol Heetls <br /> I hmeby certily Ihat I hava read antl eaemined ihle eppliullon and know ihe eema lo be Irua aM corted.All proW�lont al lawa end oNlnence�poveminp <br /> inis lypa ol wurk wtll ba complled wllh whelher apeUOeA hemin or noL The prantinp ol e permi�doe�no�pra�ume lo pNe aut�otlty to vialale or eencel <br /> Ihe provislan ol eny other elale or locel law regulaling c:omlruction or Ihe poAormance ol con�l�ucllon.Thal I em�ulhorizotl Ey�M oh+ier ol thi�propehy <br /> to pedorm he work lor which applicellon le made entl 1 wmply wilh Iha Stele Contrecton Law iB27 RCW end YB8.200 WAC <br /> C.( /' i:r�. • ( 1� ff)1f/. c i /� Z/�"/l <br /> OwnerlAut orizodAgent Ipneturs � Dete (Revised1Y10f0) <br /> I/Z <br />