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PERMIT APPLICATION <br /> BUILDINGIMECHANICALIPLUMBINGISIGN/SPRINKLERIDEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, N/A 98201 -425-257-8810— PNC 425-257-8II57—v�nr,rw.everett�va.org <br /> APPLICATIONS ARE ACCEPTED FROM 9 AM TO 4 PM <br /> SIT,^ADD�E�: ���; ,^` \ w F.20PERNTAXII f� IT' � /�(�� <br /> ` �cuun_� �Ut UG <br /> LEGALfornewconslrucGon: ShotlFlaVsuhAivis:nn_ LoWo. _ (a1L�chcopyo(Iongleg�ICe,criplion) <br /> OWNER �U �V �Dy ��`�lNd PhoneiE-ma'd 425 - -,�l^ (�J77 <br /> nda�esslu�j2g `tvw�rurJ u' c�ry�si<«rz�n �✓wvf�" wA Q'a2o9 <br /> CONTRACTOR L'�L'I�%P-�i�l.����C j{ILZSIM�f1V L81Lic.it GU�ac�ss�z20j e.0�'� �"'�Y75 <br /> nadrese 212n aGIG�G �Uc VGR�9TGJQ�Y�Zor Phone/Ema�l T25-Z52-31�}� <br /> TENANT BUSINESS NAPdE CON�TAFT�OR£��AIT� � <br /> Sv+��vV M�V� �7 ;�{�� �� �"�` �/�,,! `u <br /> � 'f 7 0 .-�--7 plianei[-m'�+.il '�LJ '2. �Z� /� <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK 3D� g& Z <br /> Existing Use of�uilding �G�IG�' _ _ _____ HEAT SOURCE: _ <br /> Proposed Use of 6uilding__ �� Cf+�GE'__ � Gas __ Electnc Oiher_ _ <br /> Building typc: _Single ramily _Dup!ex_To�vnhouse _I,fulli-Family �Commercizl <br /> Type of pro;ecC _New _Addition _Remcdel �Repair_T.I._Sign_SprinF;ler_Demolition_Chan�e of Use <br /> DeScriptionofVJork(additior,alspacepr viCedcnlhebac.'rJ: <br /> R�/Z �f KN Gv� G,�� 5i3 c.�.�v >s�iue I-.a�•rt�� � �✓ �l yx y s�o�„� �..���u. �/ar'g <br /> Have yau started working without a permit? _YES 'L NO <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Pm�ect: _Nevf_Addn _Alteralion�,Repair Type of ProJecl: _Nevi_A'ddn _Alteration__Repair <br /> Show flwn6er/d)ollixtures Show Nuni6er(i!)o(liYlures <br /> � NC—airhand!ingur.its l�oilet <br /> � Forced air systems � ��«���� <br /> � Gas pip�ng I.avalcry h:'�sh basin) <br /> 'Nater hezter � Sho�ser <br /> Gas tirep!acr, Kitchen sink G di,posal <br /> Gas racqc Oish:vasher <br /> � Clothes dryer � Clolhc5 tvasher <br /> � I:ar.��ehc.ad � VJ:�terlienter <br /> � Exhau;t fan � Sink(servicc'hadmop/etcJ <br /> lic:,at pwnp Backllow prevenler <br /> Unit I�cotcr � Urinal <br /> � �nilcr � Drinking Fcuntain <br /> Refriqerelion � Flcor drain <br /> � Woadslove � Grease�rrtp <br /> Ductini� � Rnof drains <br /> Other � I�1eAicnl Gas <br /> SPRINKLER /SUPPRESSION SYSTEM olher. <br /> � NumLer of Heads I Oiher. <br /> I hereby cetlify Ihat I haee rcad and exomineJ Ihis ap,licatien ard kno�v Ihe:;_rne lo he Imn anJ correrl.All provision,cf la�:s and mdinnnces govemirg <br /> Ihis lype of�.+urk v.ill bo complied v.ilh vA�eU:er spedfied hCrcin or nol.The,ran(ing ef a pem�d Ao�:r.o�presume lo,iea aulhority lo vir.lale or r,ancel <br /> Ihe pmvision of any olher st�te or local Inw repul3tiny mnslruction or Ihe�;edormance of conslmaion.That I am authcri.aU by the o:�merof ihi;properP/ <br /> to pe�A i^ihe unrklor ufiich applicalion is made anA I romply ui;h ihe Slate Cunb,r.tors Law 18.27 RCW and 295.200 WAC <br /> �yC.���_ �- S-I S <br /> Bnfrr/ ullmriz d niSignafure Date (Revised2R017J <br /> �� <br />