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i � <br /> PERMIT APPLIC.�TION <br /> BUILDINGIMECHANICAUPLUM8ING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVlCES <br /> 3200 Cedar St.,Evereri,WA 98201 -425257-8810—FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM '-'g`�I <br /> SITE ADDRESS: PROPERTY TAX N PE <br /> •. � o �� -� <br /> LEGAL lor navconslruction: Short Plal/subdivisbn Lot No._ (attach wpy ol brg legal tlesuiptbn) <br /> OWNER /1/21-�{-( {-( l PhonelE-mail /.� Q l M .Q - - <br /> Address� City/Sta:e/IP �:V e2 . � <br /> CONTRACTOR7 /j L rti � I.�W' L 81 Lic.# <br /> Address/`;��./ N'i �IJV� ( - 1 � P�onelEmail 2CLP�4u '9�/ <br /> TENANT BU3INESS NAME CONTACT FOR PERMIT <br /> �H+t� CLRLIC,rtFrnl <br /> Phonn/E-mail zC�[ -��`�l-17� <br /> BUILDINGPERMITAPPLICATION cOnrancTPRiCeoFwoRK dIC�/r> <br /> Ezis6ng Use of Building HEAT SOURCE: <br /> Proposed Use of Buii ng Gas Elect�ic Other <br /> Building type: ingle Family _Duplex_Tovmhouso _Mulli•Family _Commorcial <br /> Typo of project: _Now _Addilion _Romodel __Repair_T.I._Sign_Sprinkior_�emolition_Change of Uso <br /> Destrip6on of W ork(ndddionol spnco pmvided on Ih5 bock): <br /> Have you sWrted working witl�out a pertnil? ,YES _NO <br /> MECHANICAL PEl2MIT APPLICATION PLEIMBING PERMIT APPLICATION <br /> Type of ProJect: _New Addn _A�teratlon_Rapalr Type ot ProJxl: _Naw_Add� _Altsntion_Repair <br /> ShowNum6er(qJo/flirtures SfawN�mbsr P olfirNrer <br /> � AIC-airhandlin units I Toilot <br /> Forcetl air s slems Bathtub <br /> � Gas i in Lavato wash basin <br /> I Watorheater Shower <br /> � Gas(replaco I Kitchen sink 8 Ais sal <br /> � Gas ran o Dishwashor <br /> I Clolhes d er I Cbthes washer <br /> � Ran c hood Water hoator <br /> Exhausl fan I Sink servicdbarlmo atc. <br /> Heal um Back�ow revenler <br /> � Unit heatar � Urinal <br /> I Boiler I Drinkin Founlain <br /> I Refn eralion Floor drain <br /> � Woodstovc Greasa Va <br /> � Ouctin I Rool drains <br /> � Other Medical Gas <br /> SPRINKLER I SUPPRESSION SYSTEM otner: <br /> � Num7er of Heads I Other: <br /> I hereby canify Ihat I havo mad anC ozaminod ihis appliwlion and know Iha samo to be We and cortad.All provitions ol lavrs and oNinances poveming <br /> this lypo of Hork vnll be complied with wheMer spedfiod herein or noL The granting of a pertnil daes not prosuma�o give authority to violale a cancul <br /> Iha provision ol eny olhar slaie or local law rogulcting wnstiuction or the peAortnarce ol consVuclion.That I am eulhonzeC by�ha owner of Ihis property <br /> lo peAam lhe Mwk la which applicalion is made arv:I comdY�^��e Slnle Conlradors Law 10.27 RCW en0 298.2G0 WAC <br /> � /� �i 8`�3-// <br /> p�. nerlAuth�ed Ignalure Da�u (Ravised7l2011) <br />