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_ --- _ <br /> . _ _ � _ _. <br /> � PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 -425-257-8810—FAX 425-257-8857—www.everettova.org <br /> APPLICATIONS ARE ACCEPTED FROM. AM TO 4 PM e� �-o� �7 — I Z <br /> SITEADDRESS:�� ^�CSC _ ^ p Q _Jp O��/ oa(O 7�� _ <br /> C, iy CJC <br /> LEGAL fw new constructlon: Short PlaVsuhdiWsion Lot No._ (attach copy of lorg legal description) <br /> OWNER �nJ �(}�( L4� = Phone/E-mail '-rZ -zsZ- C <br /> Address � G� �� "' _ , _v-- CitylState2ip E✓�/��� -� <br /> CONTRACTOR T�/r� - � � •i)1 � G . L&I Lic.# R�v � L ,Q <br /> Address� - L . � 1/ ti � - �S Phone/Email �j-7'7 -� � <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT 8�4�Q,� �,�GG/h� <br /> Phor,e/E•mait L,j 77�j- <br /> BUILDING PERMIT APPLICATION coNTrucT PRlce oF RK .,2 GCY��UO <br /> Exisling Use of Building <br /> Proposed Us2 0(Building_ Gas EiecWc_ Other_ <br /> Buildinglype: �SingleFamily _Duplex Townhouse _Mulli-Family _Commercial <br /> TypeotproJect: _New _Addition _Remodel _Repalr_T.I._Sign_Sprinklzr_Demolition_Ch2nge otUse <br /> DescriptionofWork(etlditlonafsp�ceprovidedonfbebacW: j�t_/�L�GC �X15�/��- GA-,5 f'L{r`LNACFi L(�/T!-f <br /> N�'W �i1 S �(�'N!r e6 -�n� 5An'l� !_OC'A-r70.•J � n1�7 N-l�ln) G!{S <br /> Have you started�vorking without a permi[7 _YES ,�NO �l�I�� , <br /> MECHANICAL PERMIT APPLICATION PLUM6ING PERMIT APPLICATION <br /> TypeotPro]eck _Nmv_Addn _Alteration_Repair TypeoiProjecL• Ne�v.�ddn _Alteration_Repatr <br /> ShmrNumber(R o/�iztures ShowfJum6er(z ol�xtmes <br /> AIC-alrhandlingunits � � Toilei <br /> Forced air s stems � Bathtub <br /> Gas Iping Levatory(wash basin) <br /> Water heater Shower <br /> Gas fireplace � Kltchen sink 8 disposal <br /> Gas range � Dishwasher <br /> � Clothes dryer � Clolhes�vasher <br /> � Range hood Water hea[er <br /> Exhausl fan Sink(service/barlmoplelc.) <br /> Heal ump � Backflow reventer <br /> Unit healer Urinal <br /> � Boller Drinking Founlain <br /> Retrigeration Floor drain <br /> Woodstove Grease trap <br /> � Ductin I Roof drains <br /> Other Medical Gas <br /> SPRINKLER/SUPPRESSION SYSTEM Other. <br /> � NumberotHezds Other. <br /> 1 hereby certify thal I have read end exsmined this epptication ond knrnv the same to be W e end conecl fUl provisions ot laxs end ordinarxes goveming <br /> this type of�wrk�dll be compiied with wfieN^r spedfled hereln or not The grnling oi a pertnit does not presume to give euthoriry to vioiale or cancei <br /> the provislon ot any other state or loal la�v regula' c�nswction w the peAortnance ot consWction.'fhat I em authoAzed by the owner ot Ihis property <br /> to pedorq�tFi�w�rk tor wfiich eppti m e d I omply with th=S�te Contractors Lsw 18.27 FCW snd 296.200 WAC <br /> �r'�7/ �� �� �-7 /7i <br /> 1j/.svL_ / <br /> Ownar uth zedAgenlSlgnaturo Oae (Revlsed22011J <br /> Y <br />