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! � � +. <br /> PERMIT APPLICATION <br /> BUILDINGIMECHANICALIPLUMBINGISIGNISPRINKLERIDEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett,WA 98201 -425-257-8810-FAX 425-257-8857-www.evereNwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 1 PM <br /> SITEADDRESS:. O� �' / 'O � + �� , ) PROPEFNTAXN PER��Z __r�-C <br /> u.—i � .) V!/J <br /> LEGAL for�ew conslrudbn: Shori PIa1lsuDdivialon Lol No._ (attach copy of bng leqal desaiption) <br /> OWNER I� r�l �Q (IL PhonelE•mall <br /> aareas � ciryrsiate�zip <br /> CONTRACTOR e�R l.� � Cn i�T L&I Lic.N U —l'I PC O ( <br /> eurege 3 jU �bl�'� Q NL l� r7 (-lJ1� PtwnelEmail Fj�' C� � 3' !2z� <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> P�ondE•mall � �� /N S '?22�( <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE oF woRK 4� :�i Od a�- <br /> Ezisling Use of Building HF�\T SOURCE: <br /> PfapOSed USe Of BUllding Gas Electric Olher <br /> Buildingtypa: �SingleFemily _Duplez_Townhousa _Mutti•Family _Commerclal <br /> Typa of projecl: _New _Addition _Remodel _Repair_T.I._Sfgn_Sprinkler_Demolilion_Change ai Use <br /> DesCriplion of Work(atldilional space provlded on the back): <br /> Have you staRed working without a permit7 YES ��NO <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> TypeofProJect: _New_Addn _Altentlon_Repalr TypeofProJ�ct: _New_Addn _Alterotlon_Rep+lr <br /> Show Number(M1 0l ftrfums Show Number(N o/flaiures <br /> AIC—airhandlin units Toilet <br /> Forced air s slems Bathtub <br /> Gas i in Levato wash basin <br /> � Wa[er heater Shower <br /> Gas fire lace Kitchen sink 8 dis osal <br /> � Gas ran e Dishwashr.r <br /> � Clothes d er Clothes washer <br /> Ran e hood Water healer <br /> Ezhaust fan Sink servicelbarfmo letc. <br /> Heat um Backflow ravenler <br /> Unit heater Urinal <br /> Boller Drinkin Fountain <br /> Retri eration Floor drein . <br /> Woodstove Grease tra <br /> Duclin Rool dreins <br /> Other Medical Gas <br /> SPRINKLER/ SUPPRESSION SYSTEM other: <br /> /�p Number o1 Heads � Other: <br /> I hereby certiy ihat 1 have reatl and ezamined lhis applicatlon and know ihe same to�e true and correcl.All provislons ol laws entl ortlinances qoveminy <br /> iMs type ot work will De complied with whether specified herein or nol.The B�anling ol a permit dces not presume to pive aulhority to violata or cancel <br /> ihe provislon of any ol�er stale or local law regulating wnslructlon or t�e peAormance ol constNction.That I am authorized by l�e owner of I�Is property <br /> to peAorm tl�e work lor which epplication Is made and I compiy wit�the State Coniractors Lew 78.27 RCW end 288.200 WAC <br /> / <br /> ���,-, ���/��s �3 -��-1 Z <br /> OwnerlAWhorized Agent Slgnetura Dale (Revisetl T/20f1) <br /> L � <br />