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� �..r I (.���� <br /> PERMIT APPLICATION <br /> BUILDINGIMECHANICALIPLUMBINGISIGNISPRINKLERIDEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett,WA 98207 -425-257•8810—FAX 425-257-8857—www.everettw .org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM I� .Z7 �� <br /> SITEADDRESS: PROPERTYTA%M PER �^� <br /> /1 L . OoH 73�Z oz uo �• <br /> LEGAL lor new construction: Short PlaVsubdivision Lot No._ (attach mpy of bnp kpal tlescriptlon) <br /> OWNER�a.�t� L �-''h�.- Ptwne/E-mail 2.S L ^� <br /> Addresa j�M/�' CitylSlale2ip <br /> CONTRACTOR ��"� Go�+-s � �' S• sf�^� L 81 Lic.# /Y! � � �' <br /> aeress/$/o N r�'r" .R 9�S`L P�ne/Email �j`Lj^L�Z -��3v <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT G.�c.�� /y�orqf�..c � <br /> oR.F+,—,c.�c� M•-�co.�,�..-:ay�.<-.». <br /> Phone/E•mail <br /> BUILDIN6 PERMIT APPLICATION coNTrincr PRice oF woRK s �= <br /> Eaisting Use of Building _ <br /> HEAT SOURCE: <br /> Proposed Use o1f,Building �ae � Eiectrk other <br /> Buildingtype: LSIngleFamily _Duplex_Townhouse _Multi-Family _Commerctal <br /> TypoofproJed: �New _Addition _Remodel _Repair_T.I._Sign_Sprinkler_Demolition_Change ofUse <br /> Description of Work(a/ddi�tional space provided on Ihe back�: /� / <br /> �t�G)4GG Co47J �OJ ��h/ G..+ I�/�� s�1 Yti C' 1 r7GPL4L� �04> /��4tC 1^ <br /> 1?Gc�1"dr L"r/TLJ i�Gnl'Y� T�rG� 494i�Gi- �e.�Ii" <br /> Have you slarted working without a permit7 _YES �,NO <br /> MECMANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Pro�ecl: �New_lltldn _Alleration_Repair Typo 01 ProJect _New_I1Adn _Altentlon_Rapair <br /> ShowNumber N o//Ixfures ShowNumber N ol/Irturea <br /> A/C-airhandlin units Toilet <br /> Forced air s stems Bethtub <br /> Gas f in Levato wash basin <br /> Waler heater Shower <br /> Gas fire �ace Kdchen sink 8 Ais osal <br /> Gas ran e Dishwasher <br /> Clothes d er Clothes washer <br /> Ran e hood Water heater <br /> Exhaust fan Sink servicelbar/mo /elc. <br /> Heat um Backflow reventer <br /> Unit heater Urinal <br /> Boiler Drinkin Fountain <br /> Refri eration Fioordrain <br /> Woodstove Grease tra <br /> Ductin Roof dreins <br /> Olher Medical Ges <br /> SPRINKLER/SUPPRESSION SY8TEM Other: <br /> Number of Heads Other: <br /> I hereby certiy that I have read and ezaminetl Mis appliwllon and know the same to be truu and cortect.All provislons ol laws and ordinances goveming <br /> this type ol vrorkwill Ee wmplied x+th whether apecife0�erein or not.The granting oi a perm�l does nol pruuma lo give aulhorily to violale or cancal <br /> the pmvlsion ol any other slata or Iocal law regulatinp construclion or the peAormance ot constmdiort Thal I am authorized by the owner ol this property <br /> to perlortn he vrork for which applicetion Is maCe anC I comply vrith the Stale Conlraclors Law 18.27 RCW and 298.200 WAC _/� <br /> �� �- �2 "'^�_�� ���w <br /> wnerlAulhodzed tSignature <br /> Dale (RevlsetlYlOf f) <br />