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c � <br /> PERMIT APPLICATION <br /> BUILDING/MECHANICAUPLUMBINGISIGN/SPRINKLER/DEMOLITION <br /> CI7Y OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett,WA 98201 -425-257-8810—FAX 425-257-8857—v.ww.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO�PM <br /> SITEADDRESS:/WII LVf�T Y`iEF� W�'T PROVENTYTAI(N �T� O _ <br /> LEGAL fa new conswction: Short RaVaubdivision Lot No._ (attadi coPY af bnp le9al desaip6on) <br /> OWNER (�1.C/ !-� G.ZL'�� PhonelE-maii <br /> dresy CilyBfetelZip <br /> corirw►croR ��o S� H � •+; �a i u�.: C�A P.�SAo�2'�,I <br /> dreu o Box� �S� u� �1 9Bsa P���� �9�•Go7� [A�Ps� .� ./� <br /> TENANT BUSINESS NAME CONTACT FOR�E�T ��n /op t�'f -(i 07 O <br /> ���b �a V V PhoneJE-mail , � Crt S I N\ �S ��� <br /> BUILDING RMIT APPLI ATION CONTRACT PRICE OF WORK //. �70 , e D <br /> Existing Use of Building �� HEAT SOURCE: <br /> Proposed Use of Buildinq G �'�1 Gas Electric other <br /> Building rype: _Single Family _Duplex_Townhouse _MuIU-Family �Commercial <br /> Type of project: _New Addilion Remodel _R�v_T.I. Sign�3prinkle/r_Demolition_pCh-arge of Use <br /> Desuiption of Work(eddd'anal space provided on�he badrl: �NS'��I� Z .(���( s��/''�S �/�Gp�/�G�Fi�{cEf <br /> q � / <br /> /�✓ �x���•�►r/ r�e.cS <br /> Have you starled working without a parmH4 YES :�NO <br /> MECHANICAL PERMIT APPLICATION �LUMBING PERMIT APPLICATION <br /> Typao(ProJect: _Naw_Addn _AllarMion_Rapair TypaofProJect: _Naw_Addn _Albretlon_Repsir <br /> Show Numbe�(A')o�flxturvs Show Numbar /W Rxtures <br /> AIC-airhandlin units I Toilet <br /> Forced air s stems Bathtub <br /> Gas i in Lavato wash basin <br /> Water heater Showe! <br /> Gas fi lace Kitchen sink&dis I <br /> Gas ran e Dishwasher <br /> Clothesd er Clotheswasher <br /> Ran e hood Water healer <br /> Exhaust fan Sink servioe/barlm etc. <br /> Hea[ um Badcflow reventer <br /> Unit heater Urina� <br /> � Boiler Drinkin Fountain <br /> I Refri eration Floordrain <br /> I Woodstove Grease ha <br /> I Ductin Roofdrains <br /> � Other � Medical Gas <br /> SPRINKLER I SUPPRESSION SYSTEM other <br /> Number ot Heads aher: <br /> I hereby certify ihal I have read and e�mined this applirafion and know lhe same to be true and cor(ect.All;xovisions of laws antl ordinances goveming <br /> this rype ot xak will be compied wiN wtielher speafied heiein w rwL Tha granting of a pertnit tloes ral presume to Bive auNaity to vidate or pncel <br /> the provision af any other sUte or local law re9ulating construction or the petfamance af consUuctim.Thffi I am autlarized by ihe wrtier ot this properry <br /> to perform the�wrk for iich applica�on is 1 comdY'�ith Ihe�Stpte ContraUors Lavi 78.27 RCW and 296.200 WAC <br /> OwneNAuNmized gent Signet� T/ ��� (Revised?!l011) <br /> �/a <br />