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PERMIT APPLICATION <br /> BUILDING/MECHANICALIPLUMBINGISIGNISPRINKLERIDEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar SL, Everett, WA 98201 -425-257-8810-FAX 425-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITEADDRESS: PROPENTYTA%p PE(iM1T^ —�� <br /> //02 Gra� �' _ oay 822�0/500 �.- ��� <br /> LEGAL�or new mnstrucuon� Shoit PiaUsu�tl�vision <br /> Lot No��1V����ach copy ol lon9le9al descnption) <br /> / �arv;�a c <br /> OWNER Q/Q ,�/ Phonei6mail ZrJ• ' <br /> Atldress . � Zz � (,�G� %i rL SU� City/5talelZ�p n 5 �L � �� �� L��'' <br /> CONTRACTOR ��-� L 8 I Lic.# <br /> Phone�Email <br /> ,tlJress <br /> (ENANT dUSINESS NAME CONTACT FOR PERMIT <br /> Phoncl6man <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> HEATSOURCE�. <br /> E*isting Use of Building �/ f <br /> Proposed Use of Building cJ�/{7ll /—l�1/�1��rf/GYP//If1l�/ Gas_ Eiectnc_ Oiner_ <br /> Building lype', ✓Sinqle Famdy _Duplex_ ownhouse _Multi-Family _Commercial <br /> Type of project: ✓New _Addition _Remodel _Repair_TJ.__Sign_Sprinkler_Demohtion_Change of Use <br /> Descript�on ot Work(adtlAional space pmvitled on tn�back)�. , <br /> New 2 _s�v,y i,�,Bod �cyis�cfr� sr�/y/c fQ•r-iir` �csid�ce - <br /> Have you started workin�without a permil7 _YES �NO <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of ProjecU �New_A�1dn _A�teratlon_Repair Type ol ProjecC �New_Addn _Alleration_Repair <br /> Shaw Numbcr(a)o!Iislures Show Number(M)ol fix(wes <br /> ( NC—airhandlin units Toilet <br /> Forced av systems Z BathWb <br /> / Gas piping r Lavatory(wash basiN <br /> Water hea�er Shower <br /> � K�Ichen vnk 8 dlsposal <br /> / � Gas lueplace <br /> / Gas range � DisMvasher <br /> Clolhes dryer Cbthes washer <br /> Water heater <br /> / � Range hood Smk(servicelbar/mopletc.) <br /> r� Exhaustfan <br /> � Heat pump Backflow prcventer <br /> � Unit healer Urinal <br /> ' Boiler ' Drinking Fountain <br /> Refngeralion Floor tlrain <br /> Woodstove Grease lrap <br /> Ducting <br /> Roof drains <br /> Other Medical Gas <br /> SPRINKLER I SUPPRESSION SYSTEM Other: <br /> 3 �. NumUer of Heads Olher. <br /> I nereoy cendy tnat I i�a:�e read ana axam.ned tms�FP'�cat:on ana know me same io ee true antl correa nn pmv�sions ol ia��s and ortl�nanees governing <br /> ;ns type ot v.ork vnll�e compiietl vnth whether spec��ietl�erein or not The granUng ol a pe�mil tloes not presume to grve authonty to violate o�wncel <br /> Ine provi5ion 0�any olhe�state or local law regWapng conSWCtion or Ihe pedormance ol wnStmClion.That I am auihori2etl by the owner ol thi5 property <br /> to periorm the xork lor which appi�c tion is made anE I mmpry�++in the State Contractors Law 18 27 RCW antl 296200 WAC <br /> � 1 �q1ef 5iD SI�� <br /> � � <br /> I�Lt.w C. I � �v Z -/5 LCIr�- <br /> Owner/Autl�o i etl A9e�l S'gnawrc <br /> Date (Revised 7/201 q <br /> \ J �� <br />