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� � <br /> PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBINGISIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SEHVICES <br /> 3200 Cedar St., Everett, �VA 98201 -425-257-8810 - FAX 425-257-8857-v+vnv.everettwa o,�Q/ <br /> APPLICATIONS"RE ACC[PTED FROM 8 AM TO 4 PM �- Y `� �- <br /> SITEAD RES : PROPEflTYTA%q P I'ITa O �D� <br /> 6 <br /> LEGAL lor new conslmetion� Sh A PlaVsuCdivision lot No. (ivach copy el lon9 ie9al des[npbon) <br /> OWNE Y PnenelE�mad Ge.�C � , L�O>'Yl <br /> nadrr,s � cnv�statNz�o � cr e �� 203 <br /> CONTRACTOR C L&I Lic.# <br /> FCJ;ess Phooc!Ema'�I <br /> TENANT 0 SI ESS NAh7E CONTACT FOR PERNiIT <br /> P�cne/E�mai1 <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK I ('� <br /> Ezisting Use of Bwid�ng � HEAT SOURCE: <br /> Proposed Vse of Builaing /�m�vi' Clq te� _ Gas_ Eieanc_ Otner . /7- <br /> Bwlding lype: _Single Family _Dup�ex_Townhouse _MWti-Family _Commercial <br /> Type ot projecl: �New Addition _Rerr.odel _Repair_T.I._Sign_Sprinkler_Demol�lion_Change ol Use <br /> Des[ription ol Work fade�fional space p�aviCed on Me bacF): <br /> Wao� 5�7� -{'o S-frse. a�iqObcrs q`- Svrp/✓5 t,doe� ����s� �PeJ <br /> / <br /> Have you started working without a pennil7 _YES �NO I�K ��� <br /> MECHANICAL PERMII' APPLICATION � PLUMBING PERMIT APPLICATION <br /> Type ol Project: ,_New_Atldn _Mteratfon_Rep�dr Type ol ProjecL• _New_Addn _Allerelion_Repafr <br /> � S�ow NumDcr(a)of lirturrs � Show Numbcr i a)ol lirtuies <br /> � NC-art handling unds � To�lct <br /> � � Forcedairsystems I �athluG <br /> \ Gas pipin0 \ I Lavalory(wash basin) <br /> • � WaMr heater � Shower <br /> \ I Gas lireplaee � Krtchen sink 8 disposal <br /> Gas range Uishwasher <br /> � Cblhes drycr Clathes washer <br /> \ Range hood � Water I��eate <br /> Exhaust fan I \S�nk (scrvicMbarlmop/cic) <br /> \Heat pump BackOow pmventer <br /> 11aA he�;er Ui�nal <br /> Ooiler Drinki�9 Fountain <br /> Relri ralio�. Floor dr�in <br /> Woodst ve Grease tra <br /> � Duc�ing Raaf d�ains <br /> Other Medical Gas <br /> SPRINKLER ! SUPPRESSI SYSTEM othcr: <br /> Number of Heads I Other. <br /> � <br /> I hereby cerLh�hal I �avo reaa anU examir^tl ihis aDPticati�n an0 know I�e same lo be iroe and wnect.All provisions oi laws antl ortlmances qovem�ng <br /> INs rype ol work mll be comphed w�lh whetner specuie0 hereln or nat.The granting ol a perm�;tloes nnl presume to give amhonty Ia v�olale or canul <br /> the provision ol any ot�er slate or�ocal law iegulating construction or I�e pertortnance ol conslructioa Tdat 1 am au1�o�Led Oy t�o owner ol th�s properry <br /> to pe��aim Ihe�wrk for whirh ap0iicalion is made anC I comply wlh t�e Siale Contractors Law 1B 27 RCW ar.tl 296200 WAC <br /> OwnerlAulhorized Agent Slgnaluro Dale (Revised b107 iJ I <br /> i y <br />