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r <br /> PERMIT 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 /> APPLICATIONS ARE ACCEPTED FROM�A�M TO 4 PM �� '�` <br /> � ' , ; A�� -7�aao�2oo J - <br /> LEQAL for new constniclion: Short PlaVsusdivi�lon Lot No._ (attach wpy ol lorp bpal 0e�cription) <br /> OWNER �.,�� cf Sc��`d �-d,�< <r Pho��.�e+� �(�1S z.5% S I 9S <br /> A00recs /D� � r0. C�/'[C J� COylStale2lp ✓C/i 61 (�(/L� G �� <br /> CONTRACTOR �'( c k i n ti m� L 6 I Lic.N <br /> AAdre« J�?/� �. �.c � n.� � �/C 1 Phone/Email ��J � �� <br /> TENANT BU INFE NAME A IT �n <br /> PhonelE-mail � M / �Q�IQ A � ' S �� � E� <br /> dU1LDING rERMIT APPLICATION CONTRACT PRICE OF WORK r 9 DO O <br /> Ezisting Use of B�iiding HEAT SOURCE: <br /> Propoaed Use of Building � Gae_ Ekdde�other <br /> Building type: _Single Family _Duplex_Townhouse Multi-Family _i,ommercial <br /> 7yp�of proJect: _New _Addition _Remodel _Rep�ir_T.I._Sign_SPrlakler�Dsmulitlon_Ch�np� of We <br /> Descnption of WoAc(edOrtional apece pmvided o.i fhe back�: <br /> Have you atarted working without�permil? YES _NO <br /> MECHANICAL PERMIT APPLICATION PLUMSINO rERMIT Ar�LICATION <br /> TypsofProJect: _Naw_Addn _ANaratlon�Rspalr TYpsotProjeet: _�MM'—AAAn J�MM��°�—R�W�� <br /> ShowNumber(kJo//Irfurss 51rowNumMr(/ oI/trfun� <br /> A/C-air handlin units Toilel <br /> For;zd air s stems Balhtub <br /> Gas i in lavato wash basin <br /> Water heater Shower <br /> Gas freplace Kitchen cink&dis osal <br /> Gas ren e Aishwasher <br /> Clothes d er Clothea waaher <br /> Ran e hood \Vater heater <br /> � � Exhaus�(an Sink service/bar/mo /e'c. <br /> ���Heatpump Backflow reventer <br /> I Unit heater Urinal <br /> Boiler Drinkin Fountain <br /> Refr eralion - Floordrein <br /> Woodstove Grease lra <br /> �- Duc��n Roof drains <br /> Other Medical Gas <br /> SPRINKLER / EUPPRESd10N SYSTEM _ Other_ <br /> IJumber oi Heads <br /> I hereby cert:fy ihal I have read and ezamined this applicalion and know Ihe same to be irue and ccned.All provisions of laws anA oMinances poveminp <br /> this type ol work wlil he comp' with whether specif�ed herein or not.The granting o1 a permit tloes not preeume to pive authorily to vloiate or uncel <br /> Ihe prcvision ol a�yvther ate or local law re8ulatinq constmclion or the pedormance of construction.That I am eNhorizetl hy Ihe owner oi tMs property <br /> lo peA ne th �rk.(or hich a lication is ma0e and I comply with Ihe State Contractors Law 1827 RCW and 286.200 WAC <br /> ._J�-�� _ /-7 -// <br /> Owner/Authodzed Agent Signature Date (Revisad 11/lOfOJ <br />