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� � <br /> PERMIT APPLICATION <br /> BUILDING/MECHANICAUPLUMBINGlS1GN/SPRINKLERIDEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett,WA 98201 -425-257-8610—FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM � —D � `LI <br /> /�s �/ ROPER7Y PER� II�� " �O <br /> :SLC I � /S cc/ �/ � �L li/I�Jvv� <br /> LEGAi.lor new consUuGion: Shorl PlaVsubdlvislon Lot No._ (atlaUi copy of long legal descriplion) <br /> i <br /> OWNER Phorre/E-mall <br /> Atldress Gp•IState/7Jp <br /> CONTFIACTOR � ��l( �"��!�CL L&I Lic.# �I 11 � � � ZU�n� � <br /> � n�� �� � /)1/f'/ ,� C' <br /> AddBss I�Q A�n �Lv�S PhonelEmail , ,vn� �JG :5 L�,U`" G r�' <br /> TENANT BUSINESS NAME n CONTAC7 FOR PERMIT <br /> LC/�n,NG naGG C�y��c;NSYrC �1�'�N!!�l-ly J��-�iU _ �l i �Ufi 5� �� <br /> PhonefE-mail <br /> BUILDING PERMIT APPLICATIOk CONTRACT PRICE OF WORK 4�o�j .� <br /> Existing Use of Building -��7 y HEAT SOURCE: <br /> Proposed Use o(Building �a J111 i.1 AS!/! l����/t/�L�11�J�_ Gas Eledric Olher <br /> Building type: _Single Family _Duplex_Townhouse _Multi-Family �L,Commarcial <br /> TypeofproJect: _Naw _AddiUon _Remodel _Repalr_T.I.�Sign_Sprinkler_Demolllion_Change otUse <br /> DesCription a(Wark�addifional space p�ovided on the 6ack): <br /> WSrrrc ���', ¢' x fS ' �bhC��{L� � `� iGtil b irJG[� Frtc'c.� <br /> Have you started work(ng wlthout a permltl _YES �NO <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type ot ProJoct: _Now_Addn _Alleretion_Repair Type ol ProJoct: _Naw_Addn _Alteratlon_Repalr <br /> Show Number(M)ol/Ixtures Show Num6er M)oI lfxNres <br /> A1C-airhandlin units Toilet <br /> Forced air s stems Bathtub <br /> Ges i in Lavato (wash basin) <br /> Water heater Shower <br /> Gas fire lace Kitchen sink 8 dispasal <br /> Gas range Dishwasher <br /> Clothes d er Clolhes washer <br /> Ran e hood Water heater <br /> Exhaust fan Sink(service/barlmo etc.) <br /> Heat um Backflow reventer <br /> Unit heater Urinal <br /> Boiler _ Drinkin Fountain <br /> Refri eralion Floordrain <br /> Woodstove Grease lrep <br /> Duclin Roaf drains <br /> Other i�T - `+�� _ Mediwl Gas <br /> SPRINKLER/ $UPPRESSION SYSTEM otner <br /> Number of Heads <br /> I hereby certlfy that I have read and exemined this applicalion and know�he samo to be irue an0 wttect.All provisiana ot laws antl ordlnonces goveminp <br /> t�is type of work will be wmplied wilh whether s dfied herein or nol.The granting at a permN does nol presume to giva euthority to violate or cancei <br /> the provision ol any other state or lo law/(a leling consWction or lhe performa!Ke of construUion.Thel I am authorized by the owner of this property <br /> �iq.p6dorm Ihe�rork( hich appli � p,j6 d�arnd I comply wiih Ihe State Contredors law 18.27 RCW end 296200 WFC �. <br /> � ,� GJ% � / �,'y� � <br /> O nerlAuthodzod Agent Sig re �� 1 ' Date ��������� � <br /> �I� <br />