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� � <br /> PERMIT APPLICATION <br /> BUILDINGIMECHANICALIPLUMBING/SIGNISPRINKLERIDEMOLITION <br /> CI i Y OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everelt, WA 98201 425-257-8810 FAX 425-257-8f357 www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM —O�`—/ Z� <br /> SITF�ADDRFS : PROPEHTYTA%p PERMITe <br /> I AV' �I �o i cnw�+a(�P'.�o�4a� C �Zog -o"� <br /> LEGAL 1or new:enstr Uon Snort PlaVsubtlivision Lo;No_ (attach copy al long legal AescnpUon) <br /> OWNER N �T'� .,Iu✓� Phone/E�mad ��- � - Q �. <br /> utltliess ,J � �1 `u�fM1YYw(Q, CRyiStatelZip S�j(� yvT !0/S 0 ' � <br /> APPUCANT: _ _Ormer _ONne�sAgem _Conl�actor _ContraclofsAgem ��ewMtT.�;to«�uoewimciwnse�'rocmin�wne•ue:+::t��u�es;ami I <br /> CONTRACTOR Q,y'V� {I 1 L 81 Lic # COE Bus Lic # �� <br /> Addiess Phone/"emad � <br /> TENANT 6USINESS NAME CONTACT FOR PERMIT <br /> �6Y� �C2(1{ji, ��'!1'��- �(� phonerE�mad �tLr-3�3�t3��• "+�$"�""'��"�"�'/ ' <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK�O O <br /> Exisling Use ol Bu�id�ng HEAT SOURCE MQ�: �� <br /> PropCsed USC o(Ouilding Gas_ Electnc__ Other__ <br /> BwlCmg type� _Smgle Family _Duplez_Townhouse _�vtultrFamdy _Commercial <br /> Type of pro;ecf. Ner+ Adtl�lion _Remotlel _Repair TJ._Sign_Sprinkler,Demoldion_Change ol Use <br /> DESCRIPTIpN OF WORLK-(a,tldmonal space prov�dee on the back)�. <br /> �I! a S7W )�� Ut.tG� � �. 5 ua'�!'� <br /> ����� �ZLt- /•u1�7�vU�9 �tsrtz �u. �tN�u9. �5� P,�R p� 5��/C�*+*�+' � �1�1�C �Ce <br /> �:r �vw+ �f1tc �ua • <br /> MECHANICAL PE MIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Typo of Pro�ec�: _Now_Addn '_Alierallon_Repair Typo ol ProJocl• _New_Adtln __AlloraUon_Repalr <br /> Show Nurtrbcr(MJ o!hrfures Show Number(Ni ol/ixtwes <br /> A!C—au handi�ng unds Tcdet <br /> Forced a�r sysicros I Balhtub <br /> Gas Fip�n9 I Lavatory(wash basm) <br /> Walcr heater ' Shower <br /> Gas 'ireplace � Kdchen sinh 8 disposal <br /> Gas ran e D�shwasher <br /> Clothes dryer Clolhes washer <br /> ange---TiiSatt� Water heater <br /> / Exhaust fan ! Sink(scrv�ce�badmop/etc.) <br /> Heal pump B3Ckflow p�Cv�nlc� <br /> Urnl heatcr � Unwl <br /> BCder Dnnk�nq Founiain <br /> z— I Retnqerahon Flocrdram <br /> Woodstove Grease trap <br /> Uucting I Rool drams <br /> Othcr I Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM � other <br /> Number of Heads � O�her. <br /> I neicCy<eNly ihat I Oave read anE e.amined I��s appLwnon ond Anow�ne sxme to Co Vue an0 carecl All provisions ollans and orC�nances povemmq�Ois type ol�m�k vnA Ee compbed <br /> w�i�whelner sDeatiea�erein or nai.i�e granbng ol a Ocrmn aocs ne�Dresume�o grce eai�e�M�o v�olate ar cancel ine prorn��on cf any oi�er siate or bwi lax ieguiaPng cAr�svun�an <br /> That I am aulnori2eC Ey 111e o�nCr o11�is proDetty to peAcim t�e wor\fo!wT�cli appLtatron n maCe an01 mmply wi1�ihe S�alc Canl�n:tcq Lrx 10.27 RCW anG:96 200A VJAC. <br /> � � � �`,��,� ��z <br /> OwnedAutM1orized ent Signaturo Dalc IFevised 6?012) <br />