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( <br /> � PERMIT APPLICATION <br /> BUILDINGIMECHANICAL/PLUMBINGISIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT 3ERVICES <br /> 3200 Cedar St., Everett, WA 98201 -425-257-8810-FAX 425-257-8857-www.everethva.org <br /> APPLICATIONS ARE ACCEPTED FROM!AM TO 4 PM /Z / <br /> SITE. E � PROPERTYTAMM P RMR _ j'�P� <br /> �Il/ <br /> LE6Al.for new wnst ion: Sho Usubdivision Lot No._ (ettach copy ol bnp kgel tlescription) <br /> OWNER PhonelE-mail <br /> ddresc � CitylStatefZip �[ V <br /> CONTRACTOR � � L&I Lic.N �C O �Z�/ <br /> ddresa � V� �..[f✓ Pnone Emeil (c^��'" -/ S � Z�� <br /> �C� � P � ��� �A� �� �� <br /> "• ( � PhonelE-mail C 1� Sh�r y.L � t1Y� <br /> SUILDING PlRMIT APPLICATION coNrw►cr Pw oF woRK <br /> Existing Use of Building I HEAT SOURCE: <br /> Proposed Use ol Buildinq �K- / Ges Elearic aher <br /> Building type: _Single Family _ lex Townhouse _Multi•Farrdly Commercial <br /> Typeofprojeq: _New _Addition _Remodel _Repair_T.I. Sign_Sprinkler_Demolilion_Change otUse <br /> D 5cri lio ofWork(eddilionels ceproNd onfh b ck): � <br /> i nS-�a I i '3'_,�'� X � c�� �c�-� I I µr�-�`��-�d S �S� ��^ ��,'I d � �. <br /> -�t�c� c�-t.-- � ) <br /> H�ve you started workinp without a pertnk9 _YES �Y=—NO <br /> MlCMANICAL PCRMIT APPLICATION PLUMdING PlRMIT APPLICATION <br /> Type of Pro)set: _New_Addn _AttenNon_Repair Type of Projeet: _New_Addn _AIDerWon_Rep�ir <br /> SMwNumbar / o/flrNres SMwNurtibr o/llicWnr <br /> A!C—alrhantllin unds Tdlet <br /> Forcetl air s stems BalMub <br /> Gas i in Laveto wash besin <br /> Water heater Shower <br /> Gas fire lace Kitchen sink 3 tlis sel <br /> Ges ran e DlsBwasher <br /> Clothes d er Clothes washer <br /> Ran e hooO Waler healer <br /> E.#iaust Ian Sink service/bar/mo letc. <br /> Heat um Backflow reverNer <br /> Unit heater Urinai <br /> Boiler Drinkin Foumain <br /> Retn eratlon Floor drain <br /> Woodstove `- Greaset <br /> Ductin Roo1 drains <br /> Other Medical Ges _ <br /> SPRINKLlR/SUPPRESSION SY8TlM Olher. <br /> Number of Heads Olher. <br /> I hereby certiy that I have reed and exemined ihis applicetian snd know lhe seme to be true and conect.All prodsbns of laws and oMinances goveming <br /> this type ol wmk will be eomplied Nith whether specified herein or not.Tha granting ol e pertnd does not presume lo gNe eulhonry:o vialete or cancet <br /> tha provision of any other slale or local law regulating consiructian or ihe peRormance ol construction.Thet 1 am authonzed by tha w�ner of this propeAy <br /> to peAorm he rk f r which appli atio s matle end I comply wdh the Stete Contractors Lew 18.27 RCW entl 286.200 WAC <br /> l� �l C J <br /> OwnerlA i IxedAyent5lgnature Date (Revised?/201f")/ <br /> f� <br />