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� � <br /> . � PERMIT APPLICATION <br /> BUILDINGIMECHANICALIPLUMBINGISIGNISPRINKLER/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 /> APPUCATIONS ARE ACCEPTED FROM 8 AM TO a PM — /I `�Z <br /> SITE ADDRESS: � a'=V c^2c''R RJ c'N�%C Fi� ��y. PR�PEpT�'T�p PERM� O -UOS <br /> LEGAL Ior new canslruction' Short PIa1/sub0idsron Lot No_ (atla[h rvpy ol long legal QestnO��on) <br /> OYYNER.�A50� w� YJ:� PMnPlE-mdil (� � I1(p �lv�A�r7 L'�f{0��� � <br /> COmSs�a3L'J Fkfl��li�.- FI 47�D �A- Ip5 Ciry/SbteJLP i}.IJkILfI; W�' `/ �� <br /> CONTRACTOR D��E� L 8 I Lic.# <br /> �� Phone/Emaii <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> ��r.� 1/.:iAl�..c'��7 � '/ <br /> PhOn'UE-mail`31.a: ��77 7 Yo �Jl+%i/��^/ � ��}d;K11�/L: '7t/' <br />�'' BUILOING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of Building�V��-�= X HEAT SOURCE: <br /> Proposed Use of Building �l-3PLcX Gas_ Electnc _ Otner, <br /> BuilAing rype: _Single Family �C Duplex_Townhouse _Mutt�Famity _Commercial <br /> Type of projecC _Ne�.v _AddNon _Remodel IS Repair_T.I._Sign_Sprinkler_Demolition_Change ol Use <br /> DeScfiption oi Work(aaartional spata pmviaeCon IAe Dack): <br /> 29AfablUibL'd0' GrASi_i�.+e r-o� !7�?✓�L' f}Np �'G„r_ <br /> ��F?ee. uN�T- NEw �ar,.,�-��r1�. '� cb 5 � <br /> I.���;�n� �.lc-w G.���Nt<'cS � Si�ati w.� {J:SPO'.'�:tL� �W.'] �rSN,�.:=is;+[e. <br /> INSTA��- nIE•J �iANia+% tW �rca �:j��.1�5 ��1 <br /> Haveyousfartadworkingwkhoutapermft7 �(_YES _NO �3�T�yec:�.;,,\� �re�,r,��F /3,.�•;l���l <br /> MECHANIGAL PERMIT APPLICATION PIUMBING PERMIT APPLICATION <br /> Type ot ProJect _Hew_AGdn _Altoratlo��Repelr Typo of P'oJttt' _New_AAen _Alteratlon X Rapalr <br /> Show NumDer(0)of/lrtuies S�ow NuriDe�ry110/fi+Nres <br /> AIG-air�anEling unds a Toilet <br /> Forced air s lems ,� BalhtuD <br /> Gas pipin .2 lavato (wash basin <br /> Waler healer Shower <br /> Gas fire lace ul KAchen sink 8 disposal <br /> �7 Gas req e I Orshwasner <br /> C�olhes d cr „t Clolhes washcr <br /> Ran e hood Water healer <br /> Exhausl fan Sink servtce/badmo lelc. <br /> Heat um BaGcflow preventer <br /> Und heatzr I Urinai <br /> Boder �rinkm Foun�ain <br /> Rehi eraUon Flonr tlrain <br /> WOodStove GreaSe Irap <br /> Ouctin � Raoldrains <br /> Olher Medical Gas <br /> SPRINKLER !SUPPRESSION SYSTEM otncr: <br /> Number of Neads I Other: <br /> 1 Mmby certiry Ihat I have rea0 anG erammetl tnis a0.��mtion antl knrnv Ilm same to De We and mrtecf.All piovisloru ot laws antl oN�nanoes�oveming <br /> t�is rype of wvk w�ll Oc oorplied�xt�whelhor spedfied�erein or�ot.The qrantirg of a pe(mn does not Dmsumc to grve auMarfty lo violate or ranccl <br /> Ihe prov�sion o!any other:�.tate or loeal 4rv mgulaUng m�s4uctlon or Ihe peAormance of consWctlon.Ttut I am authonstl Oy Ne owner o1 thls praperty <br /> �n mrlmm Ihn rmk Irv v.h:ri annliratinn Ia matln wM 1 mmM�v.ilh�hn Sfafn(`nnlnrJmz 1 aw 1H 97 FCW�M 9AR 90D WAf. <br /> � � . r 1 <br /> u�t WvI: '„ , 5�lb��o� a— <br /> C� l �/Z <br /> � ! <br />