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w�� ��. <br /> c� (� <br /> PERMIT APP�ICATION <br /> BUILDINGIMECHANICALIPLUMBINGISIGNISPRINKLER/DEMOLITION <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 T01 PM .�7 " " <br /> $ITE ADDRESS: PROPERTYTA%N PERMI <br /> 5919 bt.ENwtw� � ��' 2e o 0 2v12oo D <br /> LEGAL(or new constnxtbn: SYArt PleVwbdivisbn lol No._ (ellech copy ol b Iagai descriptbn) <br /> OVYNER /KqN�/ � • V. I' nI�MU PhonalE-mail � ��'�'J�0 f.N��"vR(iJ�P�•W1I( <br /> Addrna u � � �� Ciry/Stat��p a�ir,µn 9e�o t <br /> CONTRACTOR � �g���� # '^""' '�/y�D� <br /> d�es$ r'j/J f�� .�1(� P,,,n,,E„e�� iv3•931—9222 <br /> TENANT � INESS� •� • �`N wn CONTACT F R PE MIT ��l/J' <br /> �Zy1JN t1611i� C <br /> ilT•r•T aB�u R �o��-�e�� �, :6 77�' U'No N fA��° � <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK_��d/a�- � <br /> ExisUng Use of Bullding A�� � HEAT SOURCE: <br /> Proposed Use ot Buiidi l[� �J D�VI • Gae Eiec��ie O�her <br /> Building rype: _Single Family _Duplex_Townhouse _Multi-Family _Commercial <br /> Type of project: _New �Addition _Remodel _Repair_T.1._Sign_Sprinkler_Demolition_Chanageo of Usce.... <br /> DescriPUOn of Wotk(additbnal space prov;ded ai fha beck): ��T'C,�G� wr,+� QI�N� o�nw l�� w+"�a�. <br /> l�i�Tu PI�ioGas�N� n �XP�rD �resnN4 dR�wupaPAr� ��- � Pb�Nw�u.Fb�c�e. <br /> �4- toNL�els c4M�R'�NcE +MI hflOr nanfh.at8rn�el'� �• f�'►� a a(�E�. <br /> Haw you sterted workiny without a pertnit? _YES �NO <br /> MECHANICAL PERMIT APPLICATION PLUMBIN6 PERMIT APPLICATION <br /> Typ�ofProJ�ct: _New_Addn _Altontlon_Rapair Typ�dProJ�et: _N�w_Addn _AlNntlon_R�pdr <br /> SlawNumWr dRxtw�a SlawNunWr dBxfuns <br /> I AIC—alrhandli uNts I Toilet <br /> � Forced air s tems I Balhtub <br /> I Gas I I Levato wash besin <br /> I Waler healer I Shower <br /> � Gas fire lace I Kitchen sink 8 dis sal <br /> I Gas ra e I Dishwasher <br /> I Clolhes d er � Clolhes washer <br /> � Ran e hood I Watet heater <br /> � Exhaust fan I Sink servicelbar/rtro elc. <br /> I Heat m I Backflow eventer <br /> � Unit heater I Urinal <br /> � Boiler I Ddnki Fountain <br /> I Re61 eration I Floor drain <br /> � Woodsrove I Greasetra <br /> I Ducti I Raof drai�u <br /> I �� � Medical Gas <br /> SPRINKLER I SUPPRESSION SYaTEM � 0��: <br /> � Number of Heads � Other: <br /> I hereby certi(y that I have road and examined thie epplieation ard know lhe same l0 6e we arM wnecl.All povisbns ot laws end adln�nces govemirg <br /> ihis lype of�wrk will be complied wilh wfielher specified hnrein or nol.The grentlng of a permil does nol prosume lo gWe aulhority to vblete w uncel <br /> the provision of any other slale or bcai law regulating eonstruelion or tM perfortnance of consWcOon.That I am authorized by ths o�er of thls property <br /> t rm the work for whlch application is mede and I comply wilh the Sla�e Coniraciors Law 1827 RCW and 296.20U M�AC <br /> Oxmarl hoflzadApantSlpnatun � �/�q�e l��sed?/ZOfiJ <br /> �/� <br />