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� � <br /> PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGNISPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St , Everett, WA 98201 - 425•257-8810- FAX 425-257-8857-vnw�everethva org <br /> APPUCATIONS ARE ACCEPTED FROfd 8 AM TO d PM <br /> SITEAD�RESS: • � 7ROPERTYTA%k pE tdlTe� <br /> ��� � � . �!-rl '.,t v.,�CC!' �2—�i <br /> : <br /> LEGAL lo�r.c:,c:,�>>L•�ci��� Sho:t r�n;' ' !v�s�on Lol'��_ <br /> —____'___--_—___'_—_ � (a::aclicaGlo!L^nr�:e'.JalCesurp;.cn) <br /> OWNER }-WGLL� Pr.o�e;e.ma: <br /> aaa,�,� I ' -t ,v. ;�G c�y;si,,�,.,c CU��' K-fi'�- � �d'� <br /> CONTRACTOR ` '� . '1 ' ( L 8 I L�r. = �J' C L <br /> i <br /> �.��«.s,. �'fba ` �scv� � �1d�o' P�,�:,.:�ma,� — zS—T7[.aS� — <br /> , <br /> T NANT BUSINESS NAME CONTACT FOR PER`ITT �,e \�y /� <br /> t i� r �.J/ �l'u�iL I"� <br /> J �4 � �� Pnonc/E�m;i�.; �GS� (�� <br /> BUILDIN PERMIT APPLICATION CONrrtnct PRice oF woRK_�j�[�6'-'_______ <br /> Exis�:nq Use o!Bmltling_______ _. ____ HEAT SOURCE' <br /> Proposed Use ot Building_ _________--____ _— Gas___ Eiec�nc___ Omer_. _ <br /> Bu�lding type: ___Smgle Family ___ Duplea_Tcvmhouse ___ Multi�FamuA9 �Commerr.�al <br /> iype o`proJect: ___ New _Adtl�tion ___. Remodel ___ Repac_ __. T L J=S:gn ___Spr�nkier_pemohhcn___Change cl Use <br /> DCscripi�on OI Wofk(a:YO�lronai space p�ov�dnd or,�/�o Gack): � <br /> (�1'���%l.� O�..Qr L�JLLLO .S)�'✓1 � 51.��LIG^. <br /> Have you slarted working without a permilT ___YES ____NO <br /> MECHANICAL PERMIT APPLICATIOId PLUMBING PERMIT APPLICATIOM <br /> Type of Pro)CCC ___Now___AEtln __Allcration __Repair Typc ot Pro�ecl: __New____Atldn __Aitcra�ion__._Repair <br /> Show Num6ei(p)ol Grfwes Show NumAer(a)ol firmres <br /> � A/C—avhandhngumt5 I iod0t <br /> ForceA air systems I BathWb <br /> � Gas ip;ng Lavatory(wash basin <br /> � Waler hea�rr � Shor�er <br /> Gas 5re lace i Hitd�en sinM 8 dis os:�l <br /> � Gas ranqe � D�shwasner <br /> � CloRies di er CloRies washer <br /> R;inqc liood Walcr heatcr <br /> [ahaust Inn S:nk(servicclharlmo lcic ) <br /> � Heat �um 9ackflow ievente� <br /> Unil heailr Unnal <br /> 8oiler � Dnnkinq Pcunlam <br /> Rclnqr.iation Ftoor tlrain <br /> Wootlstove Grease uap <br /> Ductmq Rool tlrains <br /> � Other_ . _____ . _.____ Lledical Gas <br /> SPRINKLER I SUPPRE$$ION SYSTEM Other <br /> � Num�er of Heads Oiher: <br /> i hereby cetl��y Ihat I nace read and e.antine�Ihis aDD''��;ion and know the sdme lo be Irue and correct.A�I provisiUns o(Id�.s anU ord�nances governrng <br /> R+�s iy0"-ol work�5ii1 be compi�e0 v:nh�chetner speuf�etl here�n or noL T�e g�anbng ot a permn tloes not presume to give authorny io v�o!a!e cr cancri <br /> in�provis�.on o�any other slate oi Iocai law regulatm9 construchon or lhe peAormance ol consimclion Thnt I am authonze�by ICn ov:ner o11r��s picperr; <br /> to�rm 1��e.ork lor xhic�apP!�cation is maae an� I comply vnih Ine State Conlraclors Law 1Q 27 RCW ano 296 2001NAC <br /> 1 Z��i��'l <br /> � er/AUlhori�SignaNro �Ddlt ({7��-c�;/y��,;7 7� <br /> ��Z <br />