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� � <br /> PERMIT APPLICATION <br /> BUILDING/MECHANICAUPLUMBING/SIGNlSPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 37.00 Cedar St, Everett, WA 98201 -425-257-881U-FAX 425-257-BE57 -�wnv everettwa.org <br /> # APi`LICATIONS AkE ACCEPTE�FROM 8 AM TO 4 PM �— 18/ Z <br /> SITE AD�RESS: PnOVER1Y iA%a PEHStIi a <br /> � as � � zo 1-oU <br /> LEGAL tor ueweer,�trucuon Snon PiavsuCe�v;sron I.oe Ho_ �attacn ccpy c!�ong tegai Cescnpt�on) <br /> OWNER KO C.f` I.���Ilq S PnonN[•mail NM(�oG) ��'3-7�1�i3 wkjaob) 6�.1- jR7� <br /> Ada«ss S10 GJct� ro., ccf S Gry�StalcrLp S�� N�c �✓5 9 ;/ <br /> CONTRACTOR U( L�1 � � L L 8 I l�c.# RERG c c s q E 1 sQ <br /> Ad,«=s Po (3oK 3�as ,4r1;� � G�� 582�3 P�o��,Ema, �r2s)a�o-vsg7 <br /> TENANT BUS�NESS NAME CONTACT FOR PERMIT <br /> O� /Vl � �. � �' Pncne�E.mai �i e4�S1fVGT�On@�9�M�1'• EOM <br /> BUIL ING PERMIT APPLICATION CONTRACT PRICE OF WORK I�I�( 702 ,O9 <br /> Exisdn9 Use of 6w'ding HEAT SOl1RCE: <br /> PrCposed U5C 0�OVilding Gas_ E�ectnc�(_ Olner <br /> Butlding type�. _Single Fam�iy _Duplez_Townheuse ��dWti•Family _Ccrnmercial <br /> Typa of pro�ect: _New _Additlon �Remodel _Repart_TJ _Sign_Spnnkler_Demol�ti:.i_C�ange ol Use <br /> Oescnp(ion ol Work faCddrenal space F�onCeC on Ine Cack)' <br /> �c�1n�0�M �IXi4�On In b�iSLM[�?" <br /> Haveyoustartedworkingwithoulapermil7 _YES _NO �pI�M�N � 'SJPPIy <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Typc ol Project: _New_Atldn �Alleratian_Repair Typc of projcr.L _Now_Aatln _AlMrolion_Repalr <br /> Show NumCcrlkl al/irNres Jlia.�ka,nb�r(qJ ol li�tu/rs <br /> NC-air handling umts Todet <br /> Forcetl art systems Balhtub � <br /> Gas G�o�ng Lovatory pvasn bas�n) <br /> Waier hea�er Sho�ver I <br /> Gas frepl�ce Kitchen s�nk&tlrsposal <br /> Gas iange Orshwashcr <br /> Clo�nes drycr Clclhes�vashr.r �, <br /> Rar.gc hood Waten c�otcr <br /> F-.nausl fan Smk(scrv¢crbaNmop/e�t) <br /> Hcat Oump � BacAllow preventer <br /> UnA heater Urmal <br /> �oiicr Dnnh:nq Fountain <br /> Retngeiahon Floor drain <br /> Woodstove Grease trap <br /> I Duthng Roof drams <br /> � Other Medical Gas <br /> SPRINKLER ! SUPPRESSION SYSTEM otner: <br /> � Num6er ol lieads I OtAer <br /> I�ere0y terbry In�l I have rca0 and e+amine0lh�s apphqilion ana know t�e same to�e Irue and corect Ail pronsions of Iaws antl orGmanws govemmg <br /> inrs ryDe of worh�.iil he comphe0 wnh whether specdled herein or not.TTe granting ol a peimA Ooes nol D�esume to grve aulnoMy to vlolate or wncei <br /> IOe p�ovision cl any otner stale or lowl Ww rcgulabn9 tonstrucbon o�tne pedormance ol w�slm:Uon Tl,�t I am authonze0 by t�e owner of Ih�s prope�ly <br /> lo Deitorm the w0�k for uT.�,ch aDC��tahon is matle anp I comply w�lh Ihe Stale Con���ctors Law 1B 27 RCVJ anC 296 200 bVAC <br /> ��u,� �.� l � G � ►� <br /> Owner/Authorl:edAgen �Ignature 08�c ii7c��srd '✓:o1f) <br />