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PERMIT APPLICATION <br /> BUILDINGIMECHANICAUPLUMBINGISIGN/SPRINKLERIDEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES S—O S `/ Z <br /> 3200 Cedar St., Everett,WA 98201 -425-257-8810—FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM E AM TO 4 PM ZQ rj' — OO <br /> SITE ADDRESS: PIIOVER7Y TA%11 PERMIT� <br /> LEGAL fw�x conttruction: ShoM1 P�aVsubOiNdon _Lol No.� (cttach copy ol bnq lepal Cewiptbn) <br /> OWNER P�one/E-mail <br /> ddrese — CirylSlatNZip <br /> CONiRACTOR L R I Lic.M <br /> eare�t 3 'c PhonelEmeM �`� <br /> TEN USIN 3 AME ON A T FOR PER <br /> Phone/E•mall 7 <br /> BUILOING PERMIT APPLICATION CONTRACT PRICE OF WORK l� 41 c� � _ <br /> Ezisting Use oi Building HEAT SOURCE: <br /> Proposed Use of Building Gae Eiectric otner <br /> Buildingtype: _SingleFamily ,�[Duplaz_Townhouse _Multl-Family _Commercial , <br /> Type ol projed: �[New _Additbn _Remodel _Repalr_T.i._Sign_Sprinkler_Demolfllon_Chenge of Ute <br /> Descriptlon of Wofk(eddlHonal apaca provlded on Ihe backJ: '�� j �� <br /> � <br /> Have you eWrted working without a psrmit? �.YES �NO <br /> MECMANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> TypeofProJscl: _New,�ddn _Altarallon_Rep�lr TypaolProJect: ShowNum6erddnol/lrlurast�un_Reptlr <br /> ShowNu.nbar olllxture+ <br /> AIC—eirhandlin unHs Toilat <br /> Forced eir s slems Bathtub <br /> Gas i in Lavato wash beain <br /> Water heater Shower <br /> Gas fin olace Kitchen sink&dis osal <br /> Gas ran-, Dishwaeher <br /> Clothes d er Clothea waeher <br /> Ren e hood Water heater <br /> Exhaust fan Sink servicelbar/mo /etc. <br /> Heat um Backflow roveMar <br /> UnR heater Urinal <br /> Boiler Drinkin Fountain <br /> Refri eration Floordraln <br /> Woodstove Groase ira <br /> Ductin Roof dralna <br /> Other Medicel Gas <br /> EPRINKLER/SUPPRESEION EYSTEM a�r: <br /> Number ol Heads Olher: <br /> I hereby certiry Ihat I have read and examined thie apPliwlion and know the same lo be 6ve anA correcl.All D�'�alont M W�'�s and oNinancee Boveminp <br /> this typa of work wll be wmplieE vrith whet�er apecifieA herein or not.The p2ntlnp o}a permA dces nW presume to pive authoMy to Holate or wncel <br /> the provision ol any olher state or local law regulating consirudion or Ihe pedormance of crnfhuqion.That I am authotlz[d bl�he oxner of thb piopxry <br /> to ped�o/�f lhe xurk lor whlch application is made and I compy with lhe State Conlractore Law 1827 RCW and 288.200 WAC <br /> / ��'7 �` //h s ���^�� (Revised 7/2of 1) <br /> OwnerlAWhorizetl Agent Signeture Dale <br /> �� <br />