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( L <br /> PERMIT APPLICATION <br /> BUILDINGIMECHANICAUPLUMBINGISIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett,WA 98201 -425-257-8810—FAX 425-257-8857—www.evereriwa.org <br /> APPUCATIONS ARE ACCEPTED FROM!AM TO 4 PM — "�Z <br /> $ITE ADDRESS• /� �( PROPENfY TAX N PERMIT f <br /> (o ��D � tnn� Rt!-1 Jt.'f1f U� <br /> LEGAL lor new conatnxlion: Ehat PlaVsubdivlebn Lot No._ (attec�copy ollaq hWlOsaalqbn) <br /> OWNER ( Q �I�QKLiStI PAondE-mall Z-D �e—QJ � O�j 6 <br /> ddreaa Z �P�� � �w� lR CltylSlatUZip � �2t.C. � 1 �O' <br /> CONTRACTOR T't�a �cNJ���.r�cl'� L 61 Lic.k �-F/E LO K Z�S� p <br /> aaree. 2`�/ -{-FYw�ff F��e C�'�•e(+c 92'z�� PtwndEmell N2S— 2R 3- ?�' �� <br /> TEN NT BUSINE S NAME ONTACT FOR PERMIT <br /> PhonelE-mail <br /> BUILOINGPERMITAPPLICATION CONTRACTPrtICEOFWORK <br /> Existing Uae ot Building_[��5i cQ u�-°-� HEAT SOURCE: <br /> � <br /> Pfoposed Use of Building (Ze �j t E U C< Gas Elatrfc Other <br /> Building type: _Singb Femily�Duplez_Townhouse _,MuttFFamily _Commercial <br /> Type of proJecl: _New Addftion _Remodal �Repair_T.I._Sign_Sprinkler_DemoliNon_Change of Use� <br /> Desuiption of Work(edaifional sparo provided on Ma nack): {�� ���.�. 1�.a�.�('-- j-P`���.y� d <br /> (�, W <br /> �Gm��� • <br /> Have you sWrtad working without a permil7 _YES _NO <br /> MECHANICAL PERMIT APPLICATION PLUMBIN6 PERMIT APPLICATION <br /> TypeofProJacl: _N�w_Addn _AlUntlon__R�p�ir Typ�olProJxL• _N�w_Addn _AlbrWon_R�p�ir <br /> Show Number ol flxturos S�aM'NumMr a���� <br /> AIC-airhandlin units Toibt <br /> Forced air s stems Bathtub <br /> Ges i in Lavalo wesh basin <br /> Water heater Shower <br /> Gas fire lace Kitchen sink d dia al <br /> Gas ran e Dishwaaher <br /> Cblhes d er CbtMa wasMr <br /> Ran e hood Water M�Mr <br /> Ezhaust fen Sink servkelbarlmo etc. <br /> Heat um Badcflow rcvemer <br /> UnR heater Udnel <br /> Boller Drinki Fountain <br /> Ref' eration Floordnin <br /> Woodstove Groase tn <br /> Ductin Roof droins <br /> Olher Medical Ges <br /> SPRINKLER/8UPPRl8SION SYSTEM other. <br /> Number of Heads OtMr. <br /> I hereEy certiy ihat I heve read an0 e:amined t�la applicatbn anE know t�e a�me to be true anE correcl.All pmvisiona ol Imn an0 ordinancea poveminp <br /> t�ie rype of wode will be complied with whether apecifiM herein or not.The pnntlny of a permit dcee not piesume to ptve aulAaily M Wdala w nncal <br /> t�e piovislon of any other alele or local law repulet' q constnxtion or iM peAortnance ol constniclbn.Thrt I em�uthorizeA W lM owner M lMs pioparry <br /> to pe th k for wfil f applice' Is compy wit�tM Stete Conireclora Lew 18.27 RCW en0 288.200 WAC <br /> �����/t- 3- I-/ Z <br /> OwnerlAuthodzM Aqant Sign�turo Deta l�d�ed 7/201f1 <br />