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PERMIT APPLICATION <br /> BUILDINGIMECHANICAL(PLUM8ING/SIGN/SPRINKLERIDEMOLITION <br /> CITY OF EVERETT PERiiAIT SERVICES <br /> :20D Cedar St., Everatt, WA 98201 -425-257-8810—FAX 425-257-8857—www.everelhva.org �t <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM � �D 3 "�r <br /> SITEADDRESS: p 1 } PNOPEN7YTAXk PERMITp ,JD^ <br /> % � �!'� �lU`f �J.+rLI� C(i2['� 47 J� <br /> LEGAL lor new conslructlon: Short PlaUsubdivision __Lol No._ (altach topy ol long legal descnptlon) <br /> P�one/E-mall � 1 C , o '] f <br /> OWNER r� �S��^+-"� . <br /> Addre.s iyl.S .Crl`� q^^e- � S_G�F c�ryisiaierz�p .�.c—c.fl �✓.A -7 ��I <br /> CONTR4CTOR � ''�� � {��—c,� L 81 Lic.A (�j� F F 1" �O lp <br /> A2Jress�C�ICI� "�7�'r�� ST 1� ,/`'�'��/-�i T��"✓h�(��y� PhoneJEmail y� \ . �]1Z• - 2.0 <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT rJ�•i-����� �� <br /> ;.�2�. �i1 51L�� <br /> PhonPJE.mau 1�C-1� bUu.l,G..��S- Ik+^�I, CJw� <br /> BUILDINGPERlMI7APPLICATION CONTRACTPRICEOFwoRK �II`[-7 __ <br /> Existing Use of Bui!ding HEAT SOURCE: <br /> Propesed Use of Building Gas_ Eiectric_ otner <br /> Building lype: _Single Famiiy _7uplex_Townhouso ✓Multl-Family _Commercial <br /> Typeofprojecl: _New _Additicn _Remodel ✓ Repair_T.I._Sign_Sprinkier_Demoiition_Chang3 olUse <br /> Descriplion o(Wo�k(addifional space p•oNded on Ihe bacN : '�`� _� ,N �K v -�� <br /> rcpl�,civ.. d1.�..�r s.,_,w...)� �rii-�.� n..� st,�....� r�.,�— l�.titr, r<Q � � � <br /> rniliw� ��,1��..�.,rl��, \ / <br /> Havo you slartod working wilhout a permit7 _YES ✓NO <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> TypeolProJect; _New_�dtln _Alteretlon_Repxir TypoofProJect: _Naw_Addn _Alteratlon_Repalr <br /> Shaw Numbcr(N)o!lixiures Show NamM1er(f!J ol0xtures <br /> NC-air handling unils Toilel <br /> forced air s stems � Bathtub <br /> Gas i in Lavato vrash basin <br /> � Waler heater Shower <br /> � Gas fireplaco Kitchen sink 8 dis osal <br /> Gas ran e Dishwasher <br /> Clothes dryer Clolhes washer <br /> Ran e hood Water healer <br /> Exhausl fan � Sink(servicelbadmop/elc.) <br /> Heal Fump Bac�flow revanter <br /> Unit healer Urinal <br /> aoiler Drinkin Fountain <br /> � Refrineration Floordiair <br /> � Woodstove Grease lra <br /> � Ductin __ Roof Arains <br /> � Olher_ Medical Gas <br /> SPRINKLER I SUP'PRESSION SYSTEM I Oiher: <br /> NumberofHeads li I Olher. YG•.��K ✓Y. �U[ 51.,r�.�^-� n� <br /> �hereby cert Ihet I ham read and ezamined Ihis eppliwllon and know the same l0 6e ime and a+rred.All provisions ol laws antl ordinances gaveming <br /> Ihis ty ol ork++vll be wmplied with whet�er specifM herein or not.Tha grentlnq of a permA tices not presume to give authority to violate or wncel <br /> Iho pr vis111b ol any olher state or local law repulaling conslruction or Ihe petlortne�w of construction.That I em authodzetl by Iho mvner ot this property <br /> to peA rm t vrork^la wfiich epplicallon Is medn and I compy vnlh tho Slate Contractors La�v 1827 RCW and 298200 WAC <br /> I '� v 5.�� 1Z <br /> OwnedA�Uthodzed Agent Signaluw Date (ReWsed 7/201p <br />