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( <br /> PERMIT APPLICATION <br /> BUILDINGIMECHANICAL/PLUMBINGISIGNISPRINKLERIDEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES SSOT-3 Z� <br /> 3200 Cedar St., Everett, WA 98201 -425-257-8810-FAX 425-257-8857-www.evere a.org � <br /> APPLICAT�ONS ARE ACCEPTED FROM 8 AM TO 4 PM G 2O I l <br /> SITE ADDRESS: PROPERN TAIf N PF�MIT M <br /> �S' �05 - I�I l� ' � n '�- <br /> LEGAL lor new conslruction: S�oh PleVsubdivlsion Lot No._ (atlach copy ol bnp legal descriptbn) <br /> OWNER A�u E N�+zn 1_�-G PhonP1E•mail 5 - 7M3' I l I$ <br /> ddress �'f" V.e jE City/StetelZip ([- �jFi01'� <br /> CONTRACTOR �C L&I Lic.# a- � <br /> ddress �` �1�e SF PMnUEmall y�5 ' y - \"l18 <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> PhonelE-mall � � ��SS� W 25 'lV3'�l IQ <br /> BUILDING PERMIT APPLICATION CON7fencT aaICE oF WORK <br /> Exisling Use of Bui�ding HEAT SOURCE: <br /> Proposad Use of Building�,Qy�_Qr^S a� '�" Gas ✓Etectric Other <br /> Buildingtype: ✓�ingleFamily _Duplex Townhousa _Multi-Family _Commercial <br /> Type ot projed: vl�ew _Addition _Remodel _Repair_T.I._Sign_Sprinkler_Demoiition_Chnnge of Use <br /> Description ol Work(addiffonal space provldetl on fhe bacl�: <br /> Iv e,w SFR <br /> Have you started working wilhout a pertnit7 _YES ✓NO <br /> MECMANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of ProJecL• �/�lew_Addn _AlteraUon_Repair Type of ProJxt: ✓1��w_Addn _AIGnUon_R�pdr <br /> Show NumDer(N)oI flstures S�ow Num�er(M)o/Bxtures <br /> AIC-airhandlin unils Toilet <br /> Forced air s stems Bathtub <br /> bas i in i I Lavato wash bas(n <br /> � Watc heater Shower <br /> Gas fire laca 1 Kitchen sink&dis osal <br /> Gas ran e Dishwasher <br /> Ciothesd er Clotheswasher <br /> Ran ehood '.�o — eate <br /> Exhausl fan Sink servi�re/bar/rtw lelc. <br /> Heat um Backflow reventar <br /> Unil heater Urinal <br /> Boiler Drinkin Founlain <br /> Refri e2lian Floor drain <br /> Woodstove Grease tra <br /> � Ductin Rootdrains <br /> � Olher Medical Gas <br /> SPRINKLER /SUPPRESSION SYSTEM Other: <br /> Number of Heads Other: <br /> I hereby cerlify ihal I have read and examinetl this appliwlion and know the same lo be true antl correct.All provisions ol laws and ortlinances goveming <br /> this rypa ol vrork will be complietl with whether specified herein or nol.The g2nting of a permit dces not presume to giva authori�y to violate ar wncel <br /> the provision ol any other state or Ixal law repulaling construction or t�e pertomiance of const�udion.Ti�al I am autho�ized by the owner ol lMs property <br /> lo peAortn the xork for which applicetlon is made and I compy with the State Contredors Law 78.27 RCW and 298.200 WAC <br /> � � � �� I (a�l1i <br /> Ownarl ulhorized Agent Sl eture Dale (RaWsed?/701/) <br /> ��v <br />