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.. . ' - <br /> ' ( �_ <br /> PERMIT APPLICATION <br /> BUILdINGIMECHANICAL/PLUMBINGISIGNISPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett,WA 96207 -425-257-8810—FAX 425-257-8657—www.evereriwa.org <br /> � p 1L APPLICATIONS ARE ACCEPTED FROM!AM TO 4 PM <br /> ADDRES ' � � PROVERN TAX N P I i IO L <br /> �1 VtL �N .Y� � �JO�(- �7S ZOt,I$Oii <br /> LE6AL ror new consW aion: Sbat PiaVsuOAivision lol No._ (�tUc�onpY a bnQ kpsl Eewiptian) % 1.1[� i. <br /> OWNER P � a l_J_ Phone/E�mail Ko�,,:, �° - rsts . <br /> ee�.2 t 0 a�y,suidZ�o E q <br /> CONTRACTOR c�"� � L 81 Lic.� S�{f�� O I.� <br /> � I I�rE Ifbl�'t rcr�' 11� ; v�l � ill� Z•+� �4 <br /> A U INE NA ' C N A T�FOR7 ERMITI ���t��� <br /> � w�ca� PhonUEtnall ��•� ^`�� r'i14�6 .(� <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK_ 'Lp�OpO� <br /> Ezislirp Use of Buildinp HEAT SOURCE: <br /> Propo�ed Uu of Building RG�l2l( Tl Gu EkeUte Otner <br /> Buildinp type: _Sinple Family _Duplex_Townhousa _Mulli•Fami�y _CommerGal <br /> Type of project: _New _Add'Aion _Remadel _Repair_T.I.�Sign_Sprinkkr_Dertwlition _Change of Use <br /> Dafttiptio�of Work(�d0ifional spece proNtled on fhe DackJ: �A� �� 1_. • 1 <br /> T� �]MP.<< OY1� Y•�\9t (,t4'K•:/Wq L�' <br /> '4do .1.,: . � coat.! � J <br /> .--�.��. , ��.c �ov� p� . Ac� c�;�� , <br /> H,w you wrt.a wor�i�a�cho�c.w�,ntn res �No <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type ol ProJ�ct: _N�w_AAAn _I11UMIon_R�p�lr Typ�W Proj�ct: _N�w_MAn _AlqnUon_Rptlr <br /> ShowNumDer o/Hrtuni ShowNumMr o/f1+Mrs <br /> AIC—airhandlin unils Toilet <br /> Forced air s etems Balhtub <br /> Gas i in Lawto wnh basin <br /> Water heater Shower <br /> Gas fire lece Kkrhen sink 8 Cis sal <br /> Gaa ran e OiahwnMr <br /> Clothesd er Cbtheswnher <br /> Ran e hood W�ter he�ter <br /> Exhaust fan Sink �srWoelb�r/mo etc. <br /> Heat um Backflow raventer <br /> Unit healar Urinol <br /> Boiler Drinkin Fountoin <br /> Refri eration Flow dnin <br /> W oodstove Gro��e tn <br /> Dudin Roof drains <br /> Other Medical Gos <br /> EPRINKLER/ SUPPRESSION EYSTEM aner: <br /> Number of Heads OIMr: <br /> I hereby ceRily that I have reatl and examined thie appliulion and know tM wme to be true and coneU.Atl provitlont of law��nd ordinance�yovsminp <br /> t�it ty{�e ol MOAc v.ill be complietl v.ith whether epecifieG herein or not.Tl�e prontinp ol a pennit Oce6 not pnwma!�piw�Wq�ty to vldate a ancel <br /> tlx � o eny o er atatC,eH i iaw repulatinp conawction or the peAormma ol con�truUion.7Tat I am�uthorl:ee by Ma w+ner W tni�propeM <br /> Aortn the or xfii 1�ppli e 1 wmply xilh the S le Contreqon Lew 1 B27 RC W anC 298200 WAC <br /> � �'7 �� <br /> Ow�r AuthorizeA Agent Signeturo Da e (Revised 7ltOf 1) <br /> � �1� � <br /> \ � <br />