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. � � <br /> PERMIT APPLIICATION <br /> BUILDING/MECHANICALIPLUMBING/CIGN/SPRINKLER/DEMOLITION <br /> CITY OF '_VERETT PER�diT SERVIC£S <br /> 3200 Cedar St.. Everetl, WA 98201 -425-257-8810 - FAX 425-257-8857 - wvnv everethva.org <br /> ' APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PtA <br /> SITE ADDRESS: PftOPERTY TAX tt PERId1T it <br /> 25 L, - , E - <br /> LEGAL fc�,e:;con;lruclioo. Sron P'�a:is�dbC.v3mn Lcl No. (allacn cooy of long Ie,ai descnp;ion) <br /> i <br /> OWNER Tp y uq - �C�tn '-5 Phone�E��ail lfZ ��- `� �Qlo <br /> aea ,r. 'J-6 �. � �1 � C�ry�S�aicrZ�o - �j S' 3 <br /> CONTRACTOR L-�J (,� - `" N - � Z -C� L 8 I Llc � L.VL �SSDZ <br /> � <br /> nda�ess z 1 2U ��A C� -(L - � ' ( Pnone/[ma s - /[/ <br /> TENANT BUSINESS NAME CUry T�ACT FOR PERMI Ket�IS��L�S/7oR.-t2,CG7t�� <br /> K�—N :vi'(� <br /> ?Forc�[-ni.l �f-Z�� 2�-.�//4- <br /> BUILDINGPERiNITAPPLICATION CONTRACTPRICEOFWORK � <br /> p•��t r, Use of F3�Id�;— ---- - ---- ----- HE�T SOURCE: <br /> prc;;osed U=_e of B�Jding Gas__ E�.eanc On�.er_ __ <br /> Bunc��ng type: �ingle Famdy _D�p!ex_.To�vnhouse _btult�-Fam�';y _Co:nrt��erual <br /> Type of pro�ect: _New _Addd��r.n XRemodel __Repair_T.I __ 5 yn_Spnn'aler___Derro'itio�_Chance of Use <br /> Desuip!lon o(Wwk ldo�r�t,o�e�sP,ace r:,c:�:��a.,n.^t:�ctii. <br /> Havc you started working without a permit7 _YES �NO <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Typr nl Pro�ecC _New_AJdn Al�c�alion _Rep:dr Typc of Pro�ecl: _4ew_Addn _Altcratlon_Repair <br /> Shaw Numbar(u)o/Oihues Slrow Numhcr(#)o/ltrfures <br /> AiG-air hanCling urd5 I Todei <br /> forr.eA an systems I BathWb <br /> Gas .�Pinq Lovalory(tvash basin) <br /> Walei healBr Shot.er <br /> Gati fne�lote K��chen sink& dis osal <br /> Gasranqe Dishwasher <br /> CIO(hes tl cr Clolhes wa5hcr <br /> Hanqe hood Waler heater <br /> Exhaust(an Sink(servicelb,�dmoolelc <br /> I leut purnp �ackflor+preven;,r <br /> � Urit Iieiier Ur�nal <br /> Boiler �nnkmq Faunlain <br /> Refriqerabo� Floor drain <br /> Wandstn:�� Grcasc�rip <br /> Durt�r Roof drains <br /> � Olhcr �ledical Gas <br /> SPRIMKLER / SUPPRESSION SYSTEM I O�hcr. <br /> � N�mher of Nezds <br /> � I Other <br /> t <br /> I h��r�ty cerLty ihal 1 have n;aa antl eaammed INs apD��calion and knc:+lhe same to�e�rue ana correcl.All pro�isions o(�aws and ordinar.ces goveming <br /> i���s�,yce of�co�k.v�il be comp!�ed wdh nheihe�speGhed he�em o�not. Thn granh�g ol a permd does not presume lo give authonty lo violate or cancel <br /> the pro��sion ol any olher slate �-law regu�al�ng conslruction or Ihe pedormance o(onslruclioa That I am authonzed hy ihe or:ne�of Ih�s pron^riy <br /> �o pedorm'� e o�4 for�vFich ip��Ocal�cn i�. �ade and I comply wdh�he Slate Conlractors Lmv 18 27 RCIN aed 296.20G�VAC <br /> �t/1 0{ � �� �C� -/`-f -/3_ <br /> OwncrlAulhorizetlAgehS ure Date (Re�,sed?/;077J <br />