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� � �CG� L�OMC � <br /> �AN , ?��Z D <br /> 0 <br /> PERMIT APPLICATION PUBLIC wORKS <br /> BUILDINGIMECHANICALIPLUMBING/SIGNISPRINKLERIDEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Evered,WA 98201 -425-257-8870—FAX 425-257-8857—www.av/e/rettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM iG'"'I�I`I Z <br /> 81TEADD ESS: PROPERTYTA7fM PERMIT O.Z — UOJ <br /> 0 ���2�i -Fv;_2Cvr!aK,., w k y <br /> LEGAL Por new con�Inxtion: &IwA PleUsubdivl�bn Lol No._ UtUch copy W lonp leY�I dauqtbn) <br /> OYYNER �' � �Qi �/ PharolE�null <br /> reas (Q 2 q h �t I� CIy/S1�INZip e 2� <br /> CON7RACTOR U vI L61Ua8 <br /> dtlrou PtqnelEmail <br /> TE N7 B E ACT F <br /> QV LC�L�:��� C-Um ..�eV �'e�MYt L�bS—`-13`s' ��SV <br /> Phond&mell �, s c h-c�t�� � � �� c��/yls ,nt-1— <br /> BUILDIN6 PERMIT APPLICATION CONTRACT PRICE OF WORK ¢ Y� <br /> Exfeling Use ot Buiklinp HEAT SOURCE: <br /> Proposed Uae of Bullding cas EieaAc olner <br /> Buildinp type: _Singla Femlly _Duplex Townhouae _Mulll•Family _Cortunerclel <br /> TypeotproJacl: ^New _Addilfon _Remodel _Repafr_T.I._Sign_Sprinkler_OemolHion_Change o(Uee <br /> DeBUIpl10�O(Wotk(addllbnel apare proWtled on fAs back): <br /> ��s s�9h <br /> Heva you etarted working villhout e permlt7 _YES _NO <br /> MECHANICAL PERMIT APPLICATION PLUMBIN� PERMIT APPLICATION <br /> TypeofProJecl: _N�w�ddnJlMrNlon_Repdr rypaolProJ�et: ,_New�ddn _AlpnUon_R�pdr <br /> ShowNumber ofltxfuru ShowNum6�r o/llxfuns <br /> A/C—etr handlin unila Toilat <br /> Forcedairs etame Balhtub <br /> Oea I In Lavato wash baaln <br /> Water Mater Shower <br /> Gas fire laoa Kitchen elnk 3 dis oael <br /> Gas ran e Dlahwather <br /> Clolhead er �tolheswaeher <br /> Re e hood Waler heater . <br /> Exheuatfan Sink service/bad elc. <br /> Heat um BadcFlow reveMar <br /> Unit healer Urinal <br /> Bofler Drinkin Founteln <br /> Ref eretion Floordraln <br /> Woodslwa Groese tr <br /> Oudin Roof dreins <br /> a�� Medlcal Gae <br /> SPRINKLER!SUPPRESSION SYSTEM olher: <br /> Number of Heeds Other: <br /> 1 hercby cerliy Ihet I heve read end exemined Ihla oppllcatlon and know Us ums W be W e antl eot2cl.All provl�bns of Iwn end ardlianca pm�mYq <br /> thb lype of wark� comD�lea xilh whsl�er epeciAM hereln or not.Ths grantMp ol a permfl doea nol prowm�W qve auVwAly b NdeU u uneel <br /> the provision� airy ol r alete or laal law reyuletinp eomlmcUon or the peiform�nce ot conswdlon.TMI I am aulhorizeE by the owna of Ih4 propeiN <br /> lo peAorm,lhe xnAc �Mlch eGp)W�lon I�meda and 1 compy xith the Slale ConlreGon l.�w 7l.T7 RCW enE 288.200 SNAC <br /> i��( <br /> `� .�C �G�G���l� G'/ � � � Z°l Z <br /> Own�r! hoHzetl Agent 91pn�tun Dato (ReWsa�d 7/1'Off) <br /> 1�Z <br />