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i <br /> PERMIT APPLICATION <br /> BUILDING;MECHANICALIPLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERAflIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 -425-257-8810—FAX 425-257-8857—www.everethva.org <br /> AppLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM C���.�I/ <br /> S ITE ADDRESS: PROPERTY TAX N PERMiT�fF��_ O <br /> l v= • £�v<%��-T% a( <br /> LEGAL lor new conslruclion: Shorl Plat/suGarvision_ Lot No._ (allach copy ol long legal descriplion) <br /> OWNER�(�i-S'C� �Gn�-rrr'�"�S Phonc/E-mail �� u�S.�-9.��� <br /> naa�e55 33°.?/;� ,,. �' e• ��r�� tL� City.'State/ZIP =l�Ef��_ GL�I{ 95'��� <br /> CONTRACTOR � [� " G L&ILic.# <br /> Address//�/s ' j)(L�/� ���/��l , ,�G�� Phone/Email a5�.�.�5� �_ ��� <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Fhone/E-mail <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK ��/�c� S?i' <br /> Existing Use of 8uildingL� HEAT SOURCE: <br /> Proposed Use of Bu�lding Gas K Electnc_ O�her_ <br /> Building lype: LC Single Fa,nily _Duplex_Townhouse _Mulli-Family _Commercial <br /> Type o(project: _New _Addilion _Remodel _Repair_T.I._Sign_Sprinkler_Demolilion_Change of Use <br /> Descriplion o(Work(additional space provided on fhe 6ack): <br /> ��7;5"fst-- Q�7�C7fC G?S' �`,� �1Gca <br /> Have you slarted working without a permit? _YES ,L NO <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Typo of ProJocl• _New,_Addn _Alteretion_Ropalr Typo of ProJocL• _Nuw_AdCn _Altaratlon_Ropalr <br /> Shaw Num6er(H)oI/ixfures Show Num6er(A)o//lxtures <br /> ,i A/C—air handlin units I Toilet <br /> Forced air syslems BathWb <br /> Gas piping Lavat�ry(wash basin) <br /> Waler heater Shower <br /> Gas fueplace Ki�chen sink&disposal <br /> Gas range Dishwasher <br /> Clolh?s dryer Clothes washer <br /> Range hood Water heater <br /> Exhaust fan Sink(service/badmop/etc.) <br /> Heal purop Back(low preventer <br /> Unit healer Urinal <br /> Boiler Drinking Fountain <br /> Refrigeration Floor drain � <br /> Woodstove Grease trzp <br /> Ducling Roof dreins <br /> Other Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM Other: <br /> Number of Heads I Olher: _� <br /> I hereGy cehiy ihat I have read and examined this applicalion and icnow I�e same to bo Irue and cortect.All pmvisions ol laws and ordinances goveming <br /> Ihis type of work wiil be complied with whether spe�ified herein or noL The granting ol a pertnit does not presume lo gire authorily lo violate or wncel <br /> the pwvision of any other slale or local law regulaling consiruction or Ihe peAormance of conslructioi�.That I am aulhodzed by the ovmer of Ihis propedy <br /> to pedorm Ihe work lor which appliwtion is made and I comply wilh the State Cunlraclors Lai�:18 27 RCW and 296.200 WAC <br /> �'�%e r �„ r �'� 9'�� �� <br /> Oy.�n rlAuthorizodAganiSignaturo Date (Re�.iseC7l20f1) <br /> �� <br />