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P'ERMIT APPLICATION <br /> BUILDING/MECHANICAUPLUMBING/SIGN/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 6 AM TO 4 PM `�,�I I <br /> N <br /> I t a � 1r1Jt t c, � U�-V <br /> LECsAL tor new conatrudion: S�o�PlaVsubdivision LO�I'37�/Zl d� �LU �m No._ (anach copy ol lorq kqal deeuiption) <br /> OYYNER ��j C Q tsDv�1,(A (� l(�1/�C er PhonelE•mail T.� � 2 S / �f 1� <br /> Orecs )�S (,� l (, �J�, �/C fL Ciry/Stete2ip " (� � <br /> cororfv,croR ����k'�� ,�u De ",� u L 3 I Lic.N <br /> Atldres6 1�ia C �f nvtJ , • ,, P,,o,,,,Em.�� y,2S 3�3`i 3/i ( <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> S 1 14��0.n� �f��Y4- I�B� <br /> Phone/E-mail � � <br /> BUILDING PERMIT APPLICATION cO�CT PRICe OF WortK � �p 6 0 <br /> Existing Use oi Building HEAT SOURCE: <br /> Proposed Use of Building Gas Ekaric✓Other <br /> Ruilding type: _Singie Family _Duplez_Townhouse _Multi•Famiiy __Commercial <br /> Type of proJect: _New _Addit(on _Remodel _Repair_T.I._Sign_Sprinkler�Demolidon_CA�npe of Use <br /> DesCfipti0n of WOfk(edditional spece providetl on the back): <br /> Mave you aprted working witAout a permil9 YES _NO <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> TypsofProj�ct: _N�w_Addn _Attrntlon_Rapalr TypaolProrel: _New_AdAn J11bnGon_Rpalr <br /> Show Number(N)of Ilxtuni Show NumDar M o/flatuns <br /> A/C—air handlin units Toilet <br /> Forced air s stema Bathtub <br /> Gas i in Lavator wash basin <br /> Water heater Shower <br /> Gas fire lace Kitchen sink 8 dis osal <br /> Gas ran e Diehwasher <br /> Clothes d er Clothes waaher <br /> Ran e hood Weter heater <br /> Exhaus�tan Sink service/trar/mo letc. <br /> Heat um Backflow reventer <br /> Unit heater Urinal <br /> Boiler Drinkin Fountain <br /> Re1ri eration Floordrain <br /> Woodstove Greane tre <br /> Ductin Roof drains <br /> Other Medical Gae <br /> SPRINKLER / SUPPREEEION SYSTEM otner <br /> Number ol Heads <br /> I hereby certify that I have read and examined Ihis application and know the same to be irue aM correq.All provislons of laws end orAin�nce6 poveminp <br /> ihis type ol work will be complied with whether specifetl herein or not.The prantlnp oi e permil dces not precume to pNe authority lo violate or uncel <br /> the pmvision ol any o sla� local law regulating constmclion or tbe peAormance of wnstruction.T�at 1 em sutborized 6y Ihe ownar ot this property <br /> lo peAorm Ihe worh or i appf ation is maae anA 1 compty with Ihe State Conlraclore Law 18.27 P.CW and 298.200 WAC <br /> /� " ��� �/! <br /> Owne�Authorized Agent Signsture Date (Reviaed 71l20f0) <br />