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� <br /> PERMIT APPLICATION <br /> BUILDING/MECHANICALIPLUMBlNGlSIGNISPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett,WA 98201 -425-257-8810—FAX 425-257-6857—www.everettwa.org <br /> APPL�CATIONS ARE ACCEPTED FROM 8 AM TO 4 PM I.� Z <br /> SITEADDRESS:��. PXOPERTYT�%11 G� L �`Y P RMI N O <br /> �j77 ��•�� f/, �e � <br /> LEGAL Iw new consWdlon: ShoA PlaVaubdivlabn LM No._ (attach copy u1 bn9 le9al OesvlOtan) <br /> OWNER Dti�1 G . �� �,� LL �- P��-��� Nti - �.'z --�2 ryd <br /> Otlress � � 7-�-�r ��/r�� L- City/Slate/Z�p � /L�"t��] �. . �� U` � <br /> CONTRACTOR �C ,'4L 'rr s'N L 8 I Lfc.B L L�'G �/ k / <br /> Atlress �i i.i/.�!'" (( � L�� C.•�%hCfa �r W� Phone/EmBil 2y �/ .�u—IJ 3�L <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> PhonefE•mail � VZQG/���� ����fJ7 '�•!J�'A <br /> BUILDINa PERMIT APPLICATION coNTR�cr PRicE oF wonK l N G UG <br /> Ezisting Use ol Building HEAT SOURCE: <br /> Proposed Use of Building Gas EieaMc Other <br /> Building rype:�.Single Family _Duplez_Townhouse _Multi•Family _Commercial �( <br /> Type of projed: _New _Addition _Remodel _Repalr_T.I._Sign_Sprinkler j�DemolRion_Change o(Use <br /> Desuiplion of Work(edditional apece podtled on fne backJ: � � <br /> �o�l�e �.C �� D --/ ' GGt � <br /> Have you started working without a pertnll7 _YES _NO <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> TypeolPro)ect: _Naw_Atldn _Alterellon_Repelr TypeofPro)ecl: _Naw_Atldn _AlterNlon_Repelr <br /> Show Number(q ol Ilnurea Show Numba(N)o!fi•tures <br /> A/C-airhandlin units Toilet <br /> Forced air s stems Bathtub <br /> Gas i in Levato wash basin <br /> � Water heater Shower <br /> � Gas fire lace Kftchen sink&dis osai <br /> Gas ran e Dishwasher <br /> Clothesd er Clotheswasher <br /> Ran e hood Water heater <br /> Exhaust fan Sink servicelbarlmo /etc. <br /> Heat um Backflow reventer <br /> Unit heater Urinal <br /> 8oiler Drinkin Foun�ain <br /> Refri eretion Floordrein <br /> Woodslove Grease tra <br /> Ductin Raof drains <br /> Olher Medfcal Gas <br /> SPRINKLER I SUPPRESSION SYSTEM other: <br /> Number of Heads � Olher: <br /> I hereby cetliry Ihal I have read and e:amined Ihis app�iwtbn an7 knav the aame lo be irua antl correct.All provislons ol laws anE ordinancef qoveminp <br /> ihis type ot vro�k will be complied with whelher specified herein or no4 7Ta pranlinp ol a permit dcec not presume to pive aW'ronty to violata or wrKel <br /> �he pmvision ol any olher atale w local law repulatin8��strucl�on or t�e pertormance ol constnKtbn.That I em authorized by the oxner ol thle property <br /> to pedorm the vmrk for wfilch application Is made and I compy vnlh ttre Stnta Contrecton Law 18.27 RCW antl 2B8.Y00'JCAC <br /> ���/ I �_ -/v _ /( <br /> OwnedAuthodzed Agenl SIgn�Wre Dale (ReNsed7l1011) <br />