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r <br /> F'ERMIT APPLICATION <br /> BUILDINGl�VIE�HANICALIPLUMBINGISIGNISPRIMKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 -425-257-8810—FAX 425-257-8857—www.everettwa.org <br /> Af'PLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM I`" '�II <br /> SITEADDRESS: �a / PROPERNTA7(p PERM � <br /> (.� <br /> LEGAL(or new conslruction: Shod PlaVsubdivision Lol No._ (altach copy ol long legal description) <br /> OWNER ,r. ��j p.� Phone�E-mail — 7 <br /> Address <br /> :,i�y.'etale/Zip <br /> CONTRACTOR L L 8 I Lic.# <br /> Address , V „�k, �� q 7 PhonelEmail � <br /> TENANT BUSINESS NAME CJNTACT FOR PERMIT <br /> Phone/E-mail <br /> BUILf]ING PERMIY APPLICAYION CONTRACT PR�::E OF WORK <br /> ExislingUseofBuilding �vSDsna � � �v�fl �_ HEATSOURCE: <br /> Proposed Use of Building Gas_ Electric_ Other_ <br /> Building type: �ngle Family _Duplex_Townhouse _Multi-Family _Commercial <br /> Type of projec�: _New _Addilion _Remodel _Repair_T.I._S!gn__Sprinkler_Demolition_Change of Use <br /> Description of Work(eddifional space provided on the back): <br /> '��. �'C �{N GFYM��ar S{S��^'� 4����1 <br /> � g�iS p,pz ex�s� ��. <br /> Have you started workfng without a permlt7 _YES ✓NO <br /> MECFSANICAL PERMIT APPLICRTION PLUMBING PERMIT APPLICATION <br /> TypoofProJocl: _Now_Addn _Alto�atlon_Ropalr TypuoiProJoct: _Now_Addn _Alteratlon_Ropair <br /> Show Num6er{M)o/Iixh.res Show Number(q)o(/lzfures <br /> � A/C—Ai� i�andling unils Toilet <br /> � Forced air syslems Bathtub <br /> Gas piping Lavalory(wash basin) <br /> a ea er Shower <br /> C:as freplace Kitchen sink&disposal <br /> Gas range Dishwasher <br /> ��� Clothes�.vasher <br /> Clo�hes dr�er <br /> Range hood Water healer <br /> Exhaust fan Sink(service/Gadmop/elc.) <br /> Heat pump � Back(Iow preventer <br /> Unil heater Urinal <br /> Roiler Drinking Fountein <br /> Refrigeralion Floor drain <br /> Woodslove Grease trap <br /> Ducting Roof drains <br /> Other Medical Gas <br /> S�RINKLEIi I SUPPI2ESSION SYSTEM otner: _ <br /> Number of Heads Other: <br /> I hereby cetlify Ihat I have read and examined this application znd know the same to be Lue and correct.All provisions of IaNs and ordinances goveming <br /> Ihis type of work will be c mpliea with whether specified herein ar nol.The p:anling of a peimit does not presume to give authorily to violate ur cancel <br /> the vision o u ihe stat or local law regulating construction or Ilie pertormanco ol conslructioa That I am aulhonzed by the owner ol this property <br /> lo p do Ihe k lor .icly�pplica�ion is mado and I comp�y vnth Ihe State Contractors Law 7827 RCW an7 296 207 WAC <br /> � / / �_ i <br /> O uthodzed Agenl Signaturo Date (Revised Z207 tJ <br />