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( <br /> PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGNISPR9NKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett,W A 98201 -425-257-8810-FAX 425257-8857-wvnv.everettwa.org <br /> APPLICATIONS ARE ACCEPTEO FROM 8 AM TO 4 PM D ��"�� <br /> SITEAODRESS: ROPERTYTAJIA PER �T� <br /> �- f Soo I Au 5 i ST: Bl�ka <br /> LEGAL tor new consirucliort Short PlaVsubdivision Lol No._ (attach copy of long legal description) <br /> OWNER � g�G 2�'EG C-� PhonelE-mail ZS�i� �.CO(p• �O 1 3 <br /> aa�es51331� -$RA-��c'�`l P�rJ pSZ NW CilylS�a�e2ipG""�CT R�'��R 9�'�3Z <br /> CONTRACTOR SI (sl�{ i��US I�L. L&ILic.# �I(s►�It�I9F���lN7 G - �'�'� 1� <br /> �dross 1 -7�5 �C �U �{ s� PhonelEmail ��- ��' ��0� <br /> - ►.,�s,zc / �sUl� ti1t��- Y�-u,�1�- <br /> sEfT�VPt^/ '��iSiNt"'�5 /Y�L PhonelE-mail zou -'7i'3- 3�Ro <br /> BUILDIPiG PERMIT APPLICATION ONTRACT PRICE OF WORK <br /> Exisling Use of Building HEAT SOURCE: <br /> Proposed Use of Building Gas Eleclric Other <br /> 8uilding type: _Single Family _Duplex_Townhouse _Multl•Family _CommerGal <br /> Type of project: _New _Addition _Remodel _Repeir_T.I._Sign_Sprinkler_Demolilion_Change of Use <br /> Description o(Work(adtlifanal space provided on Ne back): + � <br /> ���h�»� � <br /> Have you atartad working wilhout a permit7 _YE NO <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> ypeofProJect: _New_Addn _Alteratlon_Repelr TypeotPro�act: `New_Addn _Alteration_Rapalr <br /> ShowNumbar'M o/flrturec ShowNumLar M o/flxturea <br /> A!C-air handll units Tdlet <br /> Forced air s stems � BathNb <br /> Gas i in Lavat wash basln <br /> Water heater Sh°wer <br /> Gas fireplace Kitchen sink 8 disposai <br /> Gas ran e Dishwasher <br /> Clothes d er Cblhes washer <br /> Ran e hood Water heater <br /> Exhauslfan Sink servicelbadmo /etc. <br /> Heal pump Backflow revanter <br /> Unil healer Urinal <br /> Bdler Dnnkin Fountain , <br /> Refriqeration Floar drain <br /> Woodstove Grease Va <br /> Ductin Roof drains <br /> Other Medical Gas <br /> SPRINKLER I SUPPRESSION SYSTEM other: <br /> Number of!ieads Other: <br /> I hereby certily Ihat 1 have read and examined Ihis appliw�ion and krww Ihe same lo be lrue and cortad.NI Drovisions ol lavrs anC ordinances goveming <br /> this lype ol work will be complied with wholher spec�ed herein or not.The g2nting of a permit does not presume to giva authority to vio�ale or cance� <br /> the provision of any other slate or local law regulaling conslruclion or lhe peAortnance al conslruclion.That i am aulhor¢ed by the owne�of Ihis property <br /> to peAorm Ihe work lor vfiich appllwtbn is made end I wmply vnth the State Conlraclors Law 1B.27 RCW and 296.200 WAC <br /> t� /v- Y- l� <br /> O ne uthorized Agent Signature Dale (Revised7l1017) <br /> � �v <br />