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l <br /> PERMIT APRLICATION <br /> BUILDING/MECHANICAUPLUMBING/SIGNISPRINKLERIDEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 -425-257-8810—FAX 425-257-8857—www.everetlwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM —Z. 3 `—� <br /> SITEADORESS: � PROPERTYTAIfN P RMIT• <br /> (G�G' �CCKS A�/�'E 0 /O�a - O <br /> LEGAL lor new construction: Shoh PlaVsubdivision _Lot No._ (atlach copy ot lonp kgal descriplion) <br /> OWNER 110L A/�I�'! � PhonelE-mail �ZS�� � � <br /> Address .�7/ CitylStala2lp .��,e - N/ ��� <br /> CONTRACTOR � C�FIN L 8 I Lic.X <br /> lddress <br /> Phone/Email <br /> TENAN7 BUSINESS NAME CONTACT FOR PERMIT �a(,.,�$"(�d <br /> '%�,��dy� ��� Phone/E•mail ��'1 D <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of Building SC�2C � � — HEAT SOURCE: <br /> Proposed Use ot Building ����� Gas Eledric Other <br /> Building lype: _Singie Family _Duplex_Townhouse _Mulli-Family iC.Commercial <br /> Type of project: _New _Addilion _Remodel �Repair_T.I._Sign_Sprinkler_Demolition_Change of Use <br /> Description of Work(additional space provided on fhe back): <br /> ,e� ,rs�L�,..�tt'd!�-e+�- �i� s�.�G <br /> Have you shrted working without a permil? _YES _NO <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Typa ol Prokel: _Naw_Addn _Altentlon_Rapalr Typa of ProJsel _New_Addn _AINnUon_R�pNr <br /> Show Number(M)o/firtures Show NumMr(M)o/flxfuns <br /> A/C—air hand�in unils Toilet <br /> Forced air s stems Bathlub <br /> Gas pipin Lavata (wash basin) <br /> Water heater Shower <br /> Gas fireplace Kilchen sink&dis osal <br /> Gas ran e Dishwasher <br /> Clothes d er Clolhes washer <br /> Ran e hood Water heater <br /> Exhaust fan Sink(servicelbar/mo letc.) <br /> Heat pump Backflow reventer <br /> Unit heater Urinal <br /> Boiler Drinkin Fountain <br /> Refri eralion Floordrain <br /> Woodstove Grease tre <br /> Ductin Root drains <br /> Other Medical Gas <br /> SPRINKLER / SUPPRES810N SYSTEM Other. <br /> Number ot Heads Olher. <br /> I hereby cenity thal I have read end ezamined this appliwtton an!know Ine same to be Irue and corted.All provisions of laws and ordinences poveminp <br /> this type ol work will be complied wilh whelher speGfied herein or nol.The granling ol a pertnit dces nol preaume to qive aulAorlty to violate a uncel <br /> Ihe provision ol an r local law regulating wns�rudion or Ihe pertormance ol wnslrudion.Thal I am aN�orized by�he ovmer ol lhls propeAy <br /> lo perform Ihe ik lor which pp aVon is made and 1 compty with tM State Coniraclon Law 7827 RCW and 298200 WAC <br /> ' ����� <br /> Ownarl u zed gentSignaturo Dale (Revised7/ZOff) �� <br />