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NERMIT APPLICATIOh <br /> BUILDING/MECHANICAL/PLUMBINGISIGN/SPRINKLERIDEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett,WA 98201 -425-257-8810—FAX 425-'L57-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 1 PM <br /> � „J U �Z I /� `0 0 <br /> LEGAL lor now conslrucllon� Short Plal/subdivlslon lol Na._ (ettech copy ol iong lepel descripllon) <br /> OWNER Y I �. � . ��l� V, 1( PhonelE�mell 2� 7� � �i 7� .�3 <br /> Atldresa 5 � � 4 � �� I h S i S �-✓ a�yisieierziP M U i�-� L I L o �/� 9��-�� <br /> CONTRACTOR L 6 I Lic.# <br /> Addrese Phone/Emall <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT D W � : f` <br /> � <br /> PhonolE�mall �} L� � � � j � � <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK 3 S6n— � <br /> Ezisting Use of Building 1 < � �+u 4�' �' �� ���2- HEAT SOURCE: <br /> Proposed Use ol Building S i n.: S 11" � r`� �^'� i �-y Gas ElecUic O�her <br /> Building lype: Single Family _Duplex_Townhouse _Multi�Family ,_Commerclal <br /> Type of proJec�New _Addltlon �Remodel _Repalr_T.I._Sign_Sprinkler_Demolltlon_Ch�nge ol Use <br /> DesCfip�ion ol Work(edddionel spece pmvidea on Ihe beck): � 4 , ;�H�, I <br /> AA�I r,�,� ��1;�, �,,�.� M N <br /> Hava you atartod working wllhout a pertnit9 _YES _NO <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Typo ol ProJocl: _New_Addn _Alloretlon_Ropalr Type al Pro�act: _New_Addn _Alleratlon_Rep�lr <br /> Show Numbcr(a)olllxfures Show Numbor(N ol flxtures <br /> NC—air handlin un�ts Tcilel <br /> Forced air s stems '� Balhlub <br /> Gas i in Le��ato wesh basin <br /> Water heater Sho�ver <br /> Gas lireplace Kilchen sink d dis osel <br /> Gas ran e Dishwesher <br /> Clolhes dr er Cloth?s washer <br /> Ranqe hootl Wate�heater <br /> 'Z. Exhausl lan Sink servicePoerhno letc. <br /> Neal um Backlow reventer <br /> Unit heater Urinel <br /> Boiler Drinkin Fountain <br /> Refri eration Floorc'rain <br /> Woodstove Grease�tre <br /> Ductin Rooldrains <br /> Other Medical Gas <br /> SPRINKLER I SUPPRESSION SYSTEM _ Other_ <br /> Number ol Heads <br /> I haeby cetlity Ihal I heve read end ezaminod Ihis applicalion and know Ihe same�o Co Irue end correcl.All pmvlslona af laws and ordlnencee poveming <br /> Ihis typa oi work will be complie�with vA�olher specifiod hereln or noL The granting ol a permil doea nol presume lo give�mihoMy la violate or cancel <br /> Ihe provision ol any o�her slate or locnl law regulating constmction or iha pedormanco ol conslrudion.T�at I am euthorized by Ihe owner ol lhle property <br /> to pedorm Ihe work la w�ich nppliwlion Is ma and I comply wilh the State Conlradors Law 1B 27 ftCW end 2BB.Y00 W 4C <br /> � ��. � � � li � <br /> OwnerlAuthorized t9lgneluro Dato (Revise�t?/70f0) <br /> <�".. <br /> ��L <br />