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PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGNlSPRINKLERIDEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 -425-257-8810-FAX 425-257•8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM T04 PM <br /> SITEADDRESS: R , PpOVEPNTA%II RMlip <br /> �Z-- T�-a�s� a - � � �� <br /> LFGAI for ne+v conslmction: S�o�PlaUsuDaivision Lct No._ (attach copy cf lorg Icgal description) <br /> O�L'NER�U(Z J� RV(� LuT[��R� p�onelE-mail �/�. S-z Sz -b y/3 <br /> !".•ess�.IS 1'�UKILT�D pLV�� `�rUAC//- Ciry/S�alMZip �U'Y, � V� r <br /> CONTFi4CTOR SR lM�c-. L 8 I Lic.# <br /> ddress P�one/EmaA <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT y,Z S ZSR�2�j'� <br /> PhcnefE�mail ���� `r � ��TxSOh <br /> BUILDING PERMIT APPLICATION CONTRACTPRICEOFYVORK �G� <br /> Ezisling Use of Building HEAT SOURCE; <br /> Proposed Use of Building_ Gas eiectnc omer <br /> BuBding type: _Si�gle Family _Duplex_Townhouse _ldulti-Famity _Commercial <br /> Type of project: _New _Adeition _Remodel _Repair_T.I._Sign_Sprinkler_Demolition_Change of Use <br /> . DesCriplion of Work(atld�lional sFato proviCed oa(he Dack): <br /> /-�CcF.sSi/3���r1 �An,� <br /> Hava you started working without a permit7 _YES �NO <br /> MECHANICALPERMITAPPLICATION PLUMBINGPERMITAPPLICATION <br /> TypeofProject: _New_AUtln _Alleratlon_Repait TypeafProJect: _New_Atldn _Alleratlon_Repalr <br /> Show Num6er(al ol li.rfurcs Sho w NumGrr(a)ol Itriures <br /> A/C—air handling un�is Toilel <br /> Forced air s stems � Bathtub <br /> Gas piping Lavato (wash basin) <br /> � Waler healer Shower <br /> I Gas freplace Kdchen sink 8 disposal <br /> Gas ran e Dishwasher <br /> Clolhes dryer Clothes washer <br /> Range hood Water heater <br /> [xhausl fan Sink(servicel6ar/moF�etc) <br /> Heal pump � Backflow preventer <br /> Unit heater Urinal <br /> �oiter Drinkin Fountain <br /> Refrigeration Flooi drain <br /> Woodslove Grease trap <br /> Ducting Hoof drains <br /> Other Medicai Gas <br /> SPRINKLER/SUPPRESSION SYSTEM otner: <br /> Number of Neads Other: <br /> I hereby certiry Ihal I have read anC examined��is appliration anA knmv Ihe samo to be Irua ar.d correct.All provisions ol laws and or�inances goveming <br /> Inis rype ol vrork will be camplied vn(h w�et�er specifieA herein or not.TTe ganting of a permit does not D�esume Io give authonty lo viola(e or cancel <br /> tho pr vi,�on ol any olher s�ate or local law regulaling mnztruction or the petlormanco ol constmclion.Thal I am authonzed by the owner of this properry <br /> ro p or t�e vrork fer i�h ii alion I ad ana 1 campry w�th Ihe Slale Contractors Law 18.27 ftC W antl 29a.200 WAC <br /> ' 1 , �_ � //- i Z <br /> O Aul orized Agent 5ignaturo Oate (Revised7l1011) I <br /> � � <br />