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� . <br /> PERMIT APPLICATION <br /> BUILDING/MECHANICALIPLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 -425-257-8810—FAX 425-257-8857—www.everetlIw`a.or <br /> ApPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM 't —��� <br /> SITEADDRESS: u�� �Dm PROPERTYTAXp PE MIT# G <br /> � � R.i-� -0 � <br /> LEGAL for new consiruction: ShoA PlaVsubdivision Lot No.__ (attach mpy ol long legal desuipllon) <br /> OWNER � �`S "�n PhonelE-mall <br /> Atldress ,�.Y`�-Q CirylStalGZlp <br /> CONTRACTOR qV�S `ar�.5'pf`+C � qL&I Lic.# �J��� �� <br /> ddress � w�W�� �� .^ �� �vY'� 1 pZOLI phonelEmail ^��— -rj��— <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT �'�.�' p qr,1 S <br /> Phon�JE•mail �IZS��J`��— 15.5 <br /> BUILDING PERMIT APPLICATION coN7rucT PRicE oF WORK <br /> Exis�ing Use of Bui!ding _ HEAT SOURCE: <br /> Proposed Use pXf Building Gas_ Eiectnc_ other_ <br /> Buiiding lype: L Singla Family _Duplex_Townhouse _,Mulli-Family _Commercial . <br /> Type of project: _New _Addition XRemodel _Repair_T.I._Sign_Sprinkler_Demolition_Change of Uso <br /> DesCriptlon of Work(addifional space provided on the back): <br /> Re- t��-C c��a �7(`6 c�Sg S�.eak/h' •.,5 <br /> Have you started working wilhout a permit7 YES �rv0 <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Typa of ProJect: _New_Addn _Alterelion_Repalr /- Typo ol ProJect: _New_Addn _AlteraUon_Repal�/` <br /> ShowNumber(p)o//Gtures � ShowNumber(a)olBxfures <br /> AIC—airhandlingunils / Toilet <br /> ( Forced air s stems / Balhlub <br /> Gas pipin % Lavato (wash basin)� ' <br /> � Water heater / . � Shower :� <br /> � Gas fire lace / Kitchen sink&disposal <br /> Gas ran e i Dishwasher � <br /> Clothes d er Clolhes washer <br /> Range hood Water ater <br /> Exha fan Sin Tservice/badmop/etc.) <br /> Hea pum B ck0ow reventer <br /> Uni heater rinal <br /> Boil r Drinkin Founlain <br /> Ref�igeration Floor drain <br /> Woodslove Grease tra <br /> Duclin Roof drains <br /> � Olher Medical Gas <br /> SPRINKLER/ SUPPRESSION SYSTEM other: <br /> Number of Heads Olher: <br /> I hereby certiy Ihat I hava read and examined this applicalion antl know tha same lo be Irue and correct.All provisions ol�aws and ordinances goveming <br /> this type of work will be complied wilh whether specified herein or nol.The granting of a permit does not presuma to gfve aulhonty to violale or wncel <br /> Ihe provi:ion ol any other slate or local law regulating construclion or the pertortnance ol constNction.That I am authonzed by lhe owner of Ihis pmperry <br /> lo peRorm ie w k or which application Is made and 1 wmpty with the Stale Conlraclors Law 18.27 RCW and 298.200 WAC <br /> ' ' y-6-IZ. <br /> Ownerl r edAgentSignaturo Date (ftevisedT/201f) <br />