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U <br />� <br />PERMIT APPLICATION <br />BUILDING/MECHANICALIPLUMBINGISIGN/SPRINKLERIDEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 Cedar SL, Everett, WA 98201 425-257-8810 FAX 425-257-8857 �vww everettv�a.org <br />LEGAL (or new constmclion� Shon <br />rax a <br />No <br />mail <br />� <br />(attach copy ol tong le9al descnplion) <br />s-�aa -Sa l�� � <br />0 <br />LICANT:�Uvme� _Owner'sFgeni _Con�rador _Goniraetor'sAgent _Tenantim��:i,�s.�eoaieuericoo:e,,ii�om�noa...�ermco�..en��ve:pacol <br />TOR <br />� <br />s <br />— ��Y�1 <br />r:s�� -��a■.y� <br />Phone/Ema�l i � —��p � <br />��� � �R���I ? <br />TENANT BUSINE55 NAME CDNTACT FOR PERMIT �� n,.`(� 'j"1n � <br />� �C ��,,/1 o �/� �l�^, /1 �Jl/�:V �s <br />��l�i��� VI I l/� V��.J�� i.�C � PhaneiE�maii �` R V Ci Q•�,� C� �1A�J• ✓1 <br />BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br />Existing Use of Buddmg HEAT SOURCE� <br />Pwposed Use of Bcdtling Gas_ Eleclnc_ Other= <br />Building type� _ Single Family _ Duplex _Townhouse _ Multi�Family _ Commercial <br />Type of projecl- New Addtlion Remode� _ Repa�r _ T I Sign Sprmkler _Demolition__Change of Use <br />DESCRIPTION OF WORK (acd�no�ai space pro�-�deaon tne oack� <br />MECHANICAL PERMIT AR'PLICATION <br />pe of Project: _New _Addn _Altcralion _Repair <br />Show NunrOer (pJ ollix(ures <br />A/C — air handling unds <br />I Forced air svstems <br />Gas fir <br />.� <br />Number o( <br />PLUMBIPIG PERMIT APPLICATION <br />pe ol Project _New _Addn _Altcration _Repair <br />Show Numbcr (a) ollixNres <br />smk & <br />Med�cal Gas <br />Otner , <br />Other. <br />I here0y cenily I�al I have reatl anC eRdminetl I�is appl�.caLon antl know I�e 5ame lo Ee �me an0 correcl All pmvis�ons ol laws an0 ora��nances govcmmg INs IyDe ol work Ki;l Ce mmpl;:tl <br />r;in �.Mefher spenfietl �crein or nol Tne granling ol a perm0 does nol FrMume l0 9rve aN�only to vio�ale or Wncel l�e pmviLon al any olhe� 51ate or IOWI law �egulating consWtlmn <br />Tnat I am aw�onxe0 by Ihe ownet mis F�P� ='i �%�_^��'� Ine war� 1or omcn apP��whon �s ma0e an0 I comply wnn I�e Sta'c Comracton La�.v 18.27 RCW antl 296 200A N'AC. <br />� Q � � � <br />Owner/A lhorized Agent Signaturc Date (Revised 3/20t3) <br />