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( � <br /> PERMIT Ai�PLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITIUN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 -425-257-8810—FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �—/O � d� <br /> SITE ADDRESS; PROPERTY TAX N PERMIT X <br /> C N �"� - �''� <br /> LEGAL for new conslruction: Short PlaVsubdivislon Lot No._ (attach copy ot long legal descriplian) <br /> OWNER Q/J PhonelE-mafl - (p <br /> Address d [r � GtylSla�e2ip � 1�L J'T Wy� p <br /> CONTRAC70R � L � r L&I Lic.# <br /> nddress p �F�LC �/V W Phone/Emal1 • �-D 'Lrj 3 <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> p�v C� PhonelE•mail • �j 3 • �S5A(�MRai oitl <br /> BUILDING PERMIT APPLICATION CONT�acr aRlc�oF woRK ' '�'> �� <br /> SHoP� <br /> Exisling Use of Bui�ding f6 HEAT SOURCE: ��� <br /> Proposed Use of 8uilding fFL[Ty C�-LD/J Ges_ Electric_ Olher_ <br /> Building type: _Single Family _Duplex Townhouse _Multi•Family �Commercial <br /> Typeofprojecl: _New _Addition ,�Remodel _Repair_T.I._Sign_Sprinkler_Demolition_Change ofUse <br /> Description of Work(edditionel space provided on fhe back): <br /> �N11-Nr IM7'aov�ntn�r To c�nE�r� gq�.o,v <br /> Have you started working wlthout a permtt? _YES _NO <br /> MEGHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> TypF�f ProJect: _New_Addn _Alteration_Re ir Type ot ProJect: _New_Addn _Altentlon_Repair <br /> ShowNumber(q)of/lxtures � ShowNumber(N)o/llxtures <br /> AIC—air handling unit Toilet <br /> Forced air s stems Balhlub <br /> Gas piping Laveto (wash ba ' ) <br /> Water heater Shcwer <br /> Gas firepla Kilchen sink dis osal <br /> Gas ran Dishwashe <br /> Clothe dryer Clothes sher <br /> Ran e hood Water aler <br /> E aust fan Sink ervice/bar/mo /etc.) <br /> eat pump Ba Flow preventer <br /> Unit heater inal <br /> Boiler Arinkin Fountain <br /> Refrigeration Floor drain <br /> Woodslove Grease lra � � <br /> Ducling Roof dreins � <br /> Other Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM Other. <br /> Num6er of Heads Olher: <br /> I hereby ceAify thal I have read and examined Ihis applicatlon and know the same to 6e trua and correct.All provislons of laws and ordinances goveming <br /> this lype of work will be complied with whelher specified herein or no�.The granting of a pertnit does nol presume to give aulhority to violate or cancel <br /> the provision of any other state or local lew regulaling construction or the performance of construcllon.Thal I am authorized 6y lhe owner of ihis prope�ty <br /> to pertorm Ihe work for wh(ch applicallon is made and I comply wilh the Stata Conlrectors Law 78.27 RCW and 298.20D WAC /� <br /> t�0.�-�.� �IZ12�,� � 1 <br /> Owner/Authorized Agent Signature Dale (Revised 2/20f i) <br />