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pERMIT APPLICATION <br /> BUILDINGIMECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY UF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 -425-257-8810 — FAX 425-257-8857—www.everettwa.nrg <br /> APPLICATIONS ARE ACCEPTED FROM B AM TO 4 PM <br /> SITE ADDRESS: PROPEAT,Y TAX N PE�2MIT: <br /> �4���C Ev��c v2f I'1 �cL�l� 2 . <br /> v <br /> LEGAL lor new conslmciion: Shod PlaVsubdivision �� Lot No._ (a�tach copy ol Iong legal descnp6on) <br /> OWNER � ���I,�� } 7�i��.� 1 .�� P:ione/6mail V1/l0 � �I�,v, . I 1 I�(� q <br /> Address ` " ��.;1�i l �l 1 y ��- � I '` � 1 CilylSla�e2ip Sl.�i� �Il� v� 'T� 1 0 1, 1 <br /> CONTRACTOR l�,L'��1G1/1.��� I Gt�1 'U"! ,- �a i i��. � ���I.6'llGl �l UGI LP�'��`'/� _. <br /> Adtlress`I l!' �l,� L'L'L��Vl �0,�,� 1 I/�/I/�'� � I `1"1�j 2� Z ��n� <br /> 4} Phor�elEmail <br /> TENANIT BUSINESS N2AME:1 \ �, CONTACT FOR PERMIT I Q� �I <br /> �"1�� VV�j%- ✓1 V� I l I � VQJ�' S � Phane/[�mail � J L�� 7.). �1"7� "�%^ L� � (JV"i_ <br /> _� <br /> BUILDIt�lG PfRMIT APPLICATION CONTRACTPRICE OF WORK �'J� CY7�) <br /> Existing Use o(Building f�tLLli.�'!'�G.l� HEAT SOURCE: <br /> Proposed Use ol Building Gas__ Gec�nc x_ Other_ <br /> Building type: _Single family _Duplex_Townhouse _Mulli-Family �Commercial <br /> Type ol project �New _Addilion _Remodel _Repair_T.L_Sign_Sprinkler_Demolition_Change Qj.,{Jsg_,,,,,�( � <br /> Descnption of Work(additiona�space providedon fhe back): • �'��� <br /> �� ec� <br /> , •, � <br /> IIR�R�����Lv1� n�,tt�����l,�i �ct�- '?�<<n� P D�� {-DD �-�� �►;�� (�b <br /> / I �z <br /> Have you staRed working without a pertnil7 _YES _NO C �'� 6•�� <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Typo ot ProjecL• ow_Addn _Alleration_Repair Typo ol Projeet: _New_Addn _Altoration_Ropalr <br /> Show Nunr6er(N)ol/irfums Sbow Number(NJ o/OaYares <br /> A/C—air handling units Toilet <br /> Forced air syslcrtis � Bathlub <br /> Gas piping Lava�ory(wash basin) <br /> Waler heater Shower <br /> Gas f replace Kilchen sink 8 disposal <br /> Gas range Dishwasher <br /> Clo;hes dryer Glolhes washer <br /> Range hood Water healer <br /> Exhausl lan Sink(service�bar/mop/etcJ <br /> � Heat pump �ackflow prevenler <br /> Unit hmter Urinal <br /> �oilcr Drinking Fountam <br /> Refngcration Floor drein <br /> Woodstove Gmase trap <br /> Ducting Roof drains <br /> Olher Medical Gas <br /> SPRINKLER I SUPPRESSION SYSTEM Other: <br /> Nw�ber of Heads Other: <br /> I hereby certity Ihal I have read and examined Ihis applicalion and know Ihe same lo be Irue anJ conecf.All provisions of lavrs and ordinances goveming <br /> Ihi,type ol woik vdll be complied with whelher.pecified herein ar no1.The grenling ol a permil tloe.nol presume to give uWhanly lo violole or cancel <br /> Ihe provision ol any oiher stale or local low regulaling.conslruction or Ihe peAormance of cans�uclion.That I am aulhoiized by Ihe owner of Ihis propr.rry <br /> lo pedorm the wo�k.`rwhich apptiwlion is made and I comply vnlh ihe State Corlraciors law 1827 RCW and 296200 WAC <br /> n �I'�l II�7 <br /> OwnorlAu/h'vlzad Agun�`SignaWro Date /Revised 1/1071) <br /> � ����S <br />