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r <br />PERMIT APPLICA�'�ON <br />BUILDINGIMECHANICALIPLUMBINGISIGN/SPRINKLERIDE'i1tIOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 Cede.s St., Everett, WA 98201 - 425-257-8810 — FAX 425-257-8857 — www.evarettwa.org <br />pPPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM _ _ u <br />��tJvE. G�/�R�� WA <br />IornewconSWdion: Short <br />4CTOR A <br />(i�lN" i1� <br />PERMIT APPLICATION <br />Use of Building <br />LOI No._ (atlaeh eopy ol long legal desenplion) <br />PhoneJE-mail �'1'2/7. V�•03�' <br />CitylStatelZp �V�V'✓ y, "�/r` �g� <br />�� L&ILic.# 6� ' 9 • �`� <br />� �//v PhonelEmail v�•� %�•��� <br />CONTACT FOR PERMIT �����1 S AG�GG^iC <br />PhonelE-mail . ���' 0 � vV <br />CONTRACT PRICE OF WORK g <br />ised Use ot j�umm�g� ' - � <br />ng type: � Single Family _ Duplex _T wnhouse _ Multi-Family _ Cominercial <br />of projecC __ New _Addition ✓ Remodel _ Repair _ T.I. _ Sign _Sprinkler _Demolition_Change of Use <br />ription of Wofk (adtlilional spaCo p�ovidcd on Ihe back) : <br />�o �vl ��cfnvk � ya�fti• �,�� wu�c fTn� bti�'Y� <br />� you started working without a permil7 ✓ YES _NO __ <br />MECHANICAL PERMIT APPLICATION �LUMBING P�RMIT APPL.iCAT10 <br />of Project: _New _Atltln _Alteration _Repair typo ot Prqxt: _N�'M _Addn _Alteration _Repair <br />Show Numbcr (N) a/ Outure5 <br />Show Num6er pq ol fis(ures Toilet <br />WC-airhandlingunits � Bathtub <br />Forced air s stems — Lavato (wash basin) <br />� Gas pipin Shower <br />� Warer heater Kitchen sink 8 disposal <br />� Gas nreplace . . Dishwasher <br />G:�s ran e Clothes washer <br />� Clotnes d er - �i Water heater <br />� I Medical Gas <br />Othec <br />��. ti��mnerotHeads I <br />; cereby certity thaU have read anU ezamined Inis application and knowlhe same to be true antl cortect All provisions of laws antl or0inances goveming <br />�,r,:s rype of �wrk wlll Ge complied witn whether speciGeA herein or not. The granting ol a peonil dces not presume lo gi�e authonry to violale or cancel <br />ihe p�ovision ol any other slate or local law regulating construdion or the pedormance ol wnsWCUon. That I am aulhorizeE by the ovmer of this pmperty <br />to orm lhe xork tor �Mich application is maC ntl I comply vAth Ihe Slale Conlractors Law 7827 RCW and 296200 WAC <br />/ r �,w. <br />AA �7V1i� <br />1Vt, _J� " •" (Revised7/20f7) <br />Owne�/AUNo�izetl Agent Slgnalure Dale <br />x..,, .., , _ .. �� , <br />�IJ <br />