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� <br /> PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGNISPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett,WA 98201 -425-257-8810—FAX 425-257-8857—www.everellwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITEADDRESS: PROP�RNTANp PERMIi�,Zo -0 <br /> COLCIS C r' a V-P. Op-r�- ! OU(rOC�O� <br /> LEGAL for new wnslmci(on: ShoA PlaUsubdivislon�:,y � _ (altach copy of long legal desulptlon) <br /> OYYNER �osc Cv�t,t � PhonelE•mall 'LI�C.��G�`i � Iv1� <br /> ddreee � Z"� ClrylStete2�p o �-J �'���� <br /> CONTRACTOR ' &I Lic.A Y1 <br /> ddresf ,� PhonelEmail 'LlWyQ_ <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> PhonelE•mail L�� —�� �-1 — 1O ` � . <br /> BUILDING PERMIT APPLICATION coNTrtnc7PRICEOFwoRK <br /> Existing Use of Buikling HEAT SOURCE: <br /> Proposed Use of Bullding Gas_ E�eclric Other <br /> Buildingtype: ,�SingleFamily _Duplex Townhouse _Multi•Family _Commercial �/ <br /> Typaofprojed: _,New _Additlon _Remodel _Repair_T.I._Sign_Sprinklerp.0emolition_Changa ofUsa <br /> Descripllon ot Work(atlditionel space provldeeon fhe becW: .Q.�(�S�'1 ft0� QJ�t�q�Z. `0�12. C0.r Wh�G�' <br /> is �r-J�.���c� olvwr� -10 b� renno�rP�� . �I�fo -10 �h • <br /> Have you started working wilhout a parmit7 �YES _NO <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> TypaotProJe�t: _New_Adtln _Alteratlon_Repalr TypeolProJacl: _New_Addn _All�nllon_Repalr <br /> Show Num6er(NJ ol llxtures Show Number(MJ ol flxfuras <br /> AIC—airhandlin unils Toi�el <br /> Forced air s slems Balhlub <br /> Gas i in Lavato wash Easln <br /> � Water heater Shower <br /> Gas fire Iace Kitchen sink&dis osal <br /> Gas ran e Dishwasher <br /> Clothes d er Cbthas washer <br /> Ran e hood Waler heeter <br /> Exhaustfan Sink servicelbarlmo /etc. <br /> Heat um Backfiow reventar <br /> Unit healer Urinal <br /> Boiier Drinkin Fountein <br /> Refri eral(on Floordrain <br /> Woodstove Grease tra <br /> Ductin Roof drains <br /> Other Mediwl Gas <br /> SPRINKLER/SUPPRESSION SYSTEM Other: <br /> Number of Heads Other. <br /> I hercby certiy thal 1 have read antl examined ihls applicallon an0 knav Ihe same to be 1Ne and cortecl.All provisbns ol laws and ord:nances goveming <br /> Ihis type of�wrk vrill be complied wilh whelher specified herein or not.The granting of a permil dces not presume to give authonty lo violale or wncel <br /> Ihe provis�on of any other stalo or Iaai law regulatfng consiruclion or lAe peAortnance ol consWd�on.That I am autharized by��e v.mer of thls pmperty <br /> to peAorm Ihe�wrlc for which application Is meda and 1 compy with the State Contrac�on Law 18.27 RCW and 298.20o WAG <br /> �a o , a U�-.� 4 - �-iz <br /> Ownor utho zed Agun Ignature Dale (Revised 7/2017) <br /> �Theresa Y.e � - Ye� p e s �'g �.�, <br /> �1�s - 3�b� - �sq s <br />