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( c. <br /> PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT nERMIT SERVICES <br /> 3200 Cedar St., Everett,WA 98201 -q25-257-8810—FAX 425-257-8857—www.everettwa.org Z <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �"fJr�� <br /> SITEAD'JRESS: ,_ �^ PROPERNTAXp PERMIi# <br /> Z C�Vo'Y �l�l. �4/ � � S'� <br /> I_EGAL for new tonslrucllon: Shoh PlaVsubdlvislon Lot No._ (altach�py of lon8�9a1 description) <br /> OWNER �'7'H— Phone�[•mall Zf�7 27r'� <br /> ddress �Z , EV�iJ'�+./QBN �,✓C � � �✓el CltylStaleRip WA O� � <br /> CONTRACTOR ��r� �( f�C_ L&I Lic.# W I TG Ny 7�CJ <br /> ddress rr,o7 1/� Q (.� �IhWuo� lP�d' PhonelEmaH �9 �7E�—�7�' <br /> TENANT BUSINESS NAME CONTAC FOR PERMIT �.y�^�p,S�b„ ou7 � 'l�l+ra.Q, �a <br /> (/ <br /> � S . PhonelE•mail _ � —�'7� � <br /> BUILDING PERMIT APPLICATION CON7RAc7 PRICEQF WORK oo' `a <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Bullding Gas_ Electric_ Olher_ <br /> Buildingtypa: _S(ngleFami�y _Duplex_Townhouse _Multl-Famiiy _Commercial <br /> Type of proJed: _New Addition _Remodel _Repafr_T.I. Sign Sprinkler,_Demolition_Cha�ge of Use <br /> Descriptlon of WOfk(addilional space proNded on fhe back): <br /> Hava you started working without a permlt7 _YES �NO <br /> MECHANICAL PERMIT APPL{GATION PLUMBING PERMIT APPLICATION <br /> Type of ProJect: _New_Atldn _Alteretion_Repalr Type ot Project: _New_Addn _Alteration_Repalr <br /> Shaw Num6er(p)o/flxfures Show Number(%1 olllxtures <br /> A/C—airhandlingunits Toilet _ <br /> Forcedairs stems Bathtub <br /> Gas i in Lavalo wash basin <br /> Waler heater Shower <br /> Gas fire lace Kitchen sfnk&d�s osal <br /> Gas ran e D(shwasher <br /> Clolhesd er Clotheswasher <br /> Ran a hood Water heeter <br /> Exhaust fan Slnk servicelbarlmo /etc. <br /> Heat um BackFlow revanter <br /> Unit heater Urinal <br /> Boiler Drinkln Fountafn <br /> Refi eration Floordrein <br /> Woodslove Grease tra <br /> Duclin Roof drafns <br /> � Qther Medfcal Gas <br /> SPRINKLER/S[BI�PRFSSION SYSTEM other: <br /> Number of Heads Other: <br /> I hereby certiy that I have read and examined this appliwllon end knaw lhe same lo be true and wrrecl.All provislons ol laxs and ordinances poveminp <br /> Ihis type of vrork vdli be wmplied wilh whelher specifed herein or not.The B�nlln8 of a permit does not presume lo B��e euNonty to vio�ale;r cancel <br /> the provislon ol any olher slate or Iocal law regu�ating conslructlon or Ihe performance of consWctlon.That I am authorized by Iha owner of Nis property <br /> lo peAorm Ihe work for which applicatian Is made and I compry wilh Ihe Stala Conlroctore Law 78.27 RCW and 298.20U WAC <br /> ( , � � l � z � <br /> OwnerlAuthorized Agent Slgne ura ate ' (Revlsed 7/4011J l � <br />