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PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBINGfSIGNISPRINKLERIDEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 320D Cedar St., Everelt,WA 98201 -425•257-8810—FAX 425-257-8857—www.everettwa.org <br /> ApPLICATIONS ARE ACCEPTE�FROM 8 AM TO 4 PM <br /> SITE ADDRESS: / I \ NROPERtt fAX k PE. I I�� -UJ � <br /> I .; .� �� CfV\1.:�i11(+J WL� � 1 �lo <br /> lot No._ (attach coDY of long legal descnption) <br /> LEGALfornewconstructlon: ShortPlaVsubdivision – <br /> OWNER � ', t - c ^ •+�eLt PhonnJ6ma�l <br /> ddress CfL+ +� Cv lA)� l� l+ C�rylS:ate/Z1P �.,�.-r��' �/9 d <br /> CONTRACTOR ' •N� L81Lic.# <br /> �rti�re 7lw.b�.� � <br /> C�`�� ` � � �,� � Pnone�Emaii 360 b`I0��16$ � �i <br /> Address <br /> TENANT BUSINCSS NAME CONTACT FOR PERMIT <br /> ��f L�1C�1 L �� FhonelE�ma�l <br /> BUILDING PERMIT APPLICATIO CONiRACTPttICEOFwoRK <br /> HEAT SOURCE: <br /> Exisling Use of Building <br /> Gas Eledric_ Other_ <br /> Proposed Use of Buiiding — <br /> Buildingtype: _SingleFamily _Duplex,_Townhouse _N.uty-Family ±�Commercial <br /> Typeofprojecl: _New _Addition _Remodel _Repair��T.I._Sign_Sprinkler_Demolition_Change ofUse <br /> DesGiption of Work(atlditianaispaco providedon fha bacFJ: <br /> Havo you started working without a purmil7 _YES _NO <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> TypoofProJect: _New_Addn _Alteratlon_Ropalr TypoalProJect� Show�!lumber(klallirt�Qsuon_Repalr <br /> ShowNum6et(C)ollirlures � Toilet <br /> A/C–air handling units <br /> � Forcetl air systems I Bathtub <br /> Gas pipin I Lavalo wash basin) <br /> � Waler heater I Sho:+rr <br /> � Gas IireFlace � Kitchen sink 8 disposal <br /> G�s ran o Ushwasher <br /> Clothes d er I Glothes washer <br /> Range hood � YJater heater <br /> Exhaust fan � Sink(service;badmo /eta) <br /> ' � pack(Imv reveNer <br /> Hcal pump Urinal <br /> Unit healer I <br /> �mler Dtinkin Fountaln <br /> � Refri crelion Floordrain <br /> � Woodstove Greaso Irap <br /> � Ductin Roof drains <br /> � Oth.er Medical Gas <br /> SPRINKLER/ SUPPRESSION SYSTEM I other: <br /> � Number o1 Heads I Olher. <br /> I he�tby certi!y ihal I hava�cad and cramined�his apDliu�Iion and Vnc:i It:c:arno to be W0 aM CMrttt•NII p�ovis�on7 0l laws anC oMinaeCef 9overnirq <br /> this typo o(wo�k vm,l be complied xlh whelher epeuGed here�n or net.Tno graNing^I a permA dcet ncl presumo to givo authonty to violete or cancel <br /> thc provision ol any otl�or atate w local law repulalinp wns�ruclhn or Ihe pertortnance ol conftnxlbn.7hat I am authoAzed tr�Ihe axror ol this property <br /> to fcAorm 1 -k Iw whkh applicellon b m�de end I compYy wNh�be State Conlretton Law 1827 RCW and 299200 WAC <br /> � ����� � d�� L �,r�1���3„ �� <br /> Owner/AulhorRed Agent Sl�n�(uro <br /> oa.c i�eviced v.91 p <br /> i . <br /> � <br />