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( � <br /> PERMIT APPLICATION <br /> BUILDIMG/MECHANICAL/PLUMBINGISIGNISPRINKLER/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 B AM TO 4 PM <br /> SI7�E�ADDCESS: �� P110PERTYTA%N RMITN +�� <br /> LEtiAL for new construction: Short Platlsubdivislon Lot No._ (attach copy ol long lepal deaaiptlon) <br /> I � PhoneJE•mail 27'7s — / ZZ'��- <br /> OWNER CJiL� qRNt r r/ <br /> duress '�Z,� II' 4�� �4 CitylStalelZlP } 0� iN1S�7 � D�� <br /> CUNTRACTOR . 1 a �J1 L 81 Uc.# <br /> Ctlrese �.� � PtwneJEmail <br /> TENANT BUSINESS AME CONTACT FOR PERMIT <br /> �� PhonelE•mail �.y��/ —7 ZZ�Z� <br /> BUILDING PERMIT APPLI TION CONTRACT PRICE OF WORK 2h06� <br /> Fxisting Use ot Buikling Y� HEAT SOURCE: <br /> Proposed Use ot Building Gas Ekctrie Other_ <br /> Building lype: �S(ngle Femily _Duplex_Townhouse _Multi-Family _Commercial <br /> Type of proJad: _New _Addflion _Remodel _Repeir_T.I._Sign_Sprinkler�Damolitlon_Cnange of Usa <br /> Desuiplion of Wotk(adtlitional spacc provitled on t�e back): <br /> ��p 7�0 ;.F. ��t���� � 2- 5►�a5 <br /> Have you startad working without a permit4 _,YES NO <br /> MECHANICAL PERMIT APPLICATIO PLUMBING PERMIT APPLICATION <br /> TypeofProJect: _llaw_Addn _Alteratlon_Rep�lr TypaolProJect: _Naw_Addn _Altentlon_Rep�ir <br /> Show N�mAer(p)o!flrtures Show Number(t)ol flHuroa <br /> AIC-airhandlin units Toilet <br /> � Forcedairs stems I Bathtub <br /> Gas i in Lavato wash basin <br /> � Water heater Shower <br /> � Gas fire lace Kilchen sink&dis osal <br /> � Gas ran e Dishwasher <br /> � Clothes d er Cbthes washer <br /> Ran e hood Waler heater <br /> Ezhaustfan Sink service/bar/mo /etc. <br /> Heat um BackOow reventer <br /> Unit healer Urinal <br /> Boiler Drink(n Fountain <br /> Refri eralion Floor drain <br /> Woodstove Grease tra <br /> � Ouctin Roof drains <br /> � Olher MediwlGas <br /> SPRINKLER/ SUPPRESSION SYSTEM other: <br /> Number of Heads Other: <br /> 1 here�y certiry Ihal I have read and ezamined Ihis appliration antl know ihe same to be trua and wrrect..Ali provisions ol laws antl ottlinances qoverning <br /> Ihis type ol vrork wi11 be wmplietl wilh whelher specifietl herein or nal.Ttie grantln8 0l a permit dces nct presume to pive euthority lo violate or wrkei <br /> lhe provision ol any olher�ate or Iaal law regulaling consl�uction or lhe peAortnanca of conshuclion.That I am authorizetl 6y lhe wmar of t��s properry <br /> lo pe�form ihe work lor whl t applicetion is made and 1 compy with Ihe State Contradors Lew 78.27 R�W and 298.200 WAC <br /> .- � 2 <br /> OwnorlAuthorized Age a re ' ale (Ravised 7/POf f) <br /> 1 <br />