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< < <br /> PERMIT A�°PLICATION <br /> BUILDIf�G/MECHANICAL/PLUMBINGOSIGN/SPRINK�EFd/DEMOL!T10N <br /> CITY aF EVERETT PERMIT SERV!•�ES <br /> 3200 Cedar St., Everett, WA 98201 -42:i-257-82i0—FAX;25-257-Se57—www.everettwa org <br /> APPUCATION:i Ai:E ACCEPTED FROM 8 A�'?0 4 PM <br /> SITEA �ES : PROPERTYTA%q PERMI <br /> �°iz ���.c�t,� G,��- sr�f D � -0 � <br /> LEGAL'or new wnsuuctlon: F:hort PIallsubdlvislon Lot t7o._ (altach wpy of long legal�^scdptlon) <br /> OWNER �//�����'��'.� .S� ��a.� ;'honelE-mail <br /> ddrr.ca � � � �. 5�. z,9 CltylSlatelZip �(y �� � � <br /> coNrRn,c•roR/yl+f`�,d��Lt.ts�� /.c/�2�� �a i u�.u /j%/�v�Jdl.2� ,U <br /> diress <br /> $'/� /,JZ'r4 ���Sa� PhonGEmail Lj'�S��^3��� <br /> TENANT BU5INESS NAME � CUNTACT FOR PERMIT <br /> �� �/Zl�� Phone/E•mail � <br /> BUILDING PERlVIIT APPLICATION CONTRAC7 PRICE oF WORK �io.r�fl _ <br /> Exisling Use of Building �/1 .l[fGc-� _ HEAT SOURCE: <br /> Proposed Use ot Buildinq L��� � �✓�_ Gas_ Flectric_ other_ <br /> Buiidingtype: _SingleFamlly ��Duplex_Townhouse _Mult!-Family �ommerciai <br /> Typa of project: _New _Additlon _,Remodel _Repair_T.I.�Sign_Sprinkler_Demolition_Change of Use <br /> Descffpl(on of Wo(k(add(fional space provlded on Ihe back): �—� ��yL �,�5 S i Lw--�� <br /> Have you slaRed working without a permit? _YES �NO _ <br /> MECHANICAL RERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Projecl: _New_Addn _Alteratlon_Repalr Type of ProJect: _New_Addn _Alteradon_Repalr <br /> Show Num6er fM)ol flxfures Show Number(M10/fixfures <br /> AIC—air handling units Toilel <br /> Forced air systems Bathtub <br /> Gas ipin Lavato wasb basin <br /> Waler heater Shower <br /> �� Gas fire lace Kitchen stnk&dis osal <br /> Gas ran e Dishwasher <br /> Clolhes d er Ciothes washer _ <br /> Range hood Water heater <br /> Fxhaust fan Sink service/bar/mo /etc.) <br /> Heal um Backflow reventer <br /> Unit heater Urinal <br /> Boiler Drinkin Fountain <br /> ReFri erelion Floor draln <br /> Woodstove Grease lra <br /> Ductin Roof drains <br /> Other Medical Gas <br /> SpRINKLER/ Sl7PPRESSION SYSTEM other: <br /> Number of Heads Other: <br /> I hereby certiy ihat I-have rea nd examined Ihis appllwtion and know the same to be Irue and correcl.All provislons ol laws end ordinances goveming <br /> ihis lypa of work will b�.cotitplied vnlh whelher specified herein or nol.The granting ol a permit does nol piesume to give authority lo violate or wncel <br /> Ihe provlsion ot�any olher stale or local law regulating consiNcllon or the peAortnance ot cons'auction.That I am authorized by the owner of this pmperty <br /> to peAo 76e vrork for whlch applicatlon Is made and I compy with lhe Stale�Coniractors Law 18.27 RCW and 298.200 WAC <br /> -�-��Gl�'�'G� � ��'/y- <br /> Owner thorizedAgent5lgnature ale (Revlsed7i2011)� <br /> � � <br />