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( <br /> PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PL�JMBING/SIGN/SPRINKLER/D@MOLITION <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 PROM 8 AM TO 4 PM �".3�I <br /> SITE ADORESS: 8/� PROPERTY TA%k ERMIT K <br /> �✓f.�2G�E ti Wk" \a- J3 —O� <br /> LEGAL lor new construction: ShoA PlaVsubdivislon Lo�No._ (attach wpy ol long lepal des:riptlon) <br /> OWNER ' PhonelE-mail <br /> dtlress <br /> Z�LD SE 3 �`` 5-r �'^ F•0.z E q ciN�siaie�ziv Ce.� - �G <br /> CONTRACTOR � LD W L&I Lic.# H kl.�k. L O 3 <br /> ddress 'O X Z I Yi vn��nlV�e.tE 4 9Ec'7Z PhonelEmail y�.S Z73 15P$ <br /> TENAN i dU51NESS NAME CONTACT FOR PERMIT <br /> 4Z�• Z73 -15Y�3//Z.yp��{kvKBu1LD�N�.-c M <br /> 7—/vi U 8�L l; PhonelE•mail <br /> BUILDING PERMIT APPLICATION coNrruc7 PRicE oF WORK �Q., oD U <br /> ExislingUseotBuiiding eETk�C� HEATSOURCE: <br /> Proposed Use of Building �ETb�l� Gas_ Electric�[ Olher_ <br /> 8uilding type: _Single Family _Duplex_Townhouse _Multl-Family ZC Commercial <br /> Type of project: _New _Addition _Remodel _Repair�(T.I._Sign_Sprinkier_Demolition_Change of Use <br /> Descriplion of Wofk(addifional space pmvlded on the back): <br /> TI j-UR. �JTWG{ nl E't^� 7—N`�Sil.� j'R�ltb i.v ✓.�LA�T ✓O.a-C.£ . <br /> Have you started working without a permit7 _YES ,ZNO <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> TypeofProJecl: _New_Addn _Alterellon_Repalr TypaofProJect: _Naw_Addn _Alteretion_Repelr <br /> Show Number(p)ol fixfures Show Num6er(Ml olflxlures <br /> A/C—air handling units Toilet <br /> Forced air s stems Bathtub <br /> Gas pi in Lavato wash basin <br /> � Waler heater Shower <br /> Gas fire lace Kitchen sink&dis osal �. <br /> Gas ran e Dishwasher <br /> Cbthes d er C�othes washer <br /> Ran e hood Waler healer �� <br /> Exhaust fan Sink servicelbar/mo /etc. <br /> Heat um Backflow reventar <br /> Unit heater Urinal <br /> Boiler Drinkin Fountain <br /> Refri erelion Fioordrain <br /> Woodstove Grease tra <br /> � Ductin Roof drains <br /> � Other Med(cal Gas <br /> SPRINKIER 1 SUPPRESSION SYSTEM other: <br /> NumberofHeads � Other: <br /> I hereby certily thal I have read and examined lF.;s application and know lhe same lo be true and wrrect.All pravisions ol laws antl ordinances goveming <br /> Ihis type ol work will be wmplied vrilh whether specifietl herein or not The granting of a permit dces nol presume to give authority to violate or cancel <br /> !he provision ol any other stale or local law regulating conslructlon or Ihe peAortnance ol conslrucllon.That I am aulhorized by the owner ot thls property <br /> to pertorm Ihe vrork for which application Is made and I compty with Ihe Stale Conirac�ors Law 16,�7 RCW and 288.200 WAC <br /> ��jL� 3y1-30 - 1 Z <br /> wnerlAuthorizetl Agent Signature Dale (Revised 7/2011) <br /> 1/Z <br />