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v� v3 � Y� 3 ao� � o � <br /> � ' <br /> PERMIT APPLICATION <br /> BUILDINGIMECHANICALIPLUMBINGISIGNISPRINKLERIDEMOLITION <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 C `-�7 `' G <br /> SITEADDRESS• D�LERTY�n%� o .,O PE �T� _��S <br /> �f/a o,� <br /> LEGAL lor new const.uclion: ShoA PlaVsu6division Lot No._ (attach capy of long lepal desuiptlon) <br /> OWNER /,J � v ' PhonelE-mail �j0 - �G - � <br /> Address "J�7 / � /�Jf/ � 5/� CitylSlale2ip NU �c/ � <br /> � <br /> CONTRACTOR ',v � � ti5 f iutilCC L81Lia# SCIi�iNLG 9Y � <br /> J <br /> Address 3�,0 7 � 3�� �� Nw ��, ✓i L Phone/Emafl a � /O 6 5'�/ O - <br /> TENANT BUSINESS NAM� CONTACT FOR PERMIT ���,�,� �'.n �7-// a. G l <br /> y,�`,($�ylf�� PhonelE•meil ��2 S � /d �s/O <br /> BUILDING PERMIT APPLICATION CONTRACT PRlce OF WORK md°�' � <br /> Existing Use of Building m�t/�/lA ( o F�/� E HEAT SOURCE: <br /> Proposed Use of Building �/a H7` Ges_ Electric Other <br /> Building lype: _Single Family _Duplex_Townhouse _Multi-Femily �Commercial <br /> Type of project: _New _Addition _Remodel _Repair,�T.l._Sign_Sprinkler_Demolition_Change ot Use <br /> Descriplion of Work(additionel space provided on fhe ber.k): . <br /> l�' � ("/���- �^v..e lQ.t�'.J ..Fb�4�n /'�_ . <br /> Have you started working without a pertnit7 _YES _NO <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Typeo(Projsct: _New_Addn _Altewtlon_Rapalr TypeolProjaet: _New_Addn _Altention_Repdr <br /> Show Number(M)o/Ilxtures Show Number(N)o//lxtures <br /> AIC-air handlin units Toilet <br /> Forced air s stems Bathtub <br /> Gas i in Lavato (wash basin) <br /> Water heater Shower <br /> Gas fireplace Kitchen sink&dis osal <br /> Gasran e Dishwasher <br /> Clothes d er Clothes washer <br /> Ran e hood Water heater <br /> Exhaust tan � Sink(service/baNmo /etc.) <br /> Heatpum Backflow reventer <br /> Unit heater Urinal <br /> Boiler Drinkin Fountain <br /> Refri eration Floor drain <br /> Woodstove Grease tra <br /> Ductin Roof drains <br /> Olher Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM Other: <br /> Num6er of Heads Other: <br /> I hereby ceAify Ihat I hava read and ezamtned Ihis application and know Ihe same to be true and corcect.All provisions of laws and ordinances goveming <br /> this type of work vrill be complicd�Wth whether spacified herein or not.The granting of e pertnit does nol presume to give aulhoriry lo violate or cancel <br /> the pravisi of any her stale or I law r uleting conslruclion or the pertortnance oi const�uclion.Thal I am euthorized 6y the owner of this property �/� , <br /> to perto he w lor which a cation i ade and I comply with Ihe Stale Contractors Law 18.27 RCW and 298.200 WAC t V <br /> �u <br /> wnerlAuthorized gentSignature Date (Revised7/1077) <br />