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. . � � <br /> PERMIT APPLICATION <br /> BUILDINGIMECHANICALIPLUMBINGISIGNISPRINKLERIDEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett,WA 96201 -425-257-8810-FAX 425-257-8657-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM E AM TO 4 PM <br /> $ITEADD ESS: PROPERTYTAI(11 PERMITN <br /> �32 QU ' .���'�►M.� ��'+���'�. ���D� bo 375 zovl'7�o 'OZ <br /> LEGAL lor new coneWction�. Shor.F!3UcubCivisio� lot Nc._ (attech topy W laq kpel Eeacnption) � <br /> OVYNER O{"L�1t V��'�� ` �"�G PhoneiE-mail huvt+ �� t44J� d19fC4^0� � � y' < «Yh <br /> OOress Z�� l3^�IlY� '�ti� , V� CitYlState/ZiP �1'� �� I��� <br /> CONTMCTOR � I�'i:Q.G3'I G�N��TQ 1 iaw lN�- �a i u�.x SYN.�E GX 1 d f J <br /> Cdreac 1� �Fi �� � � 1L��{�fi I.V't 70�/Z Phone/Email 'TL.7 �(�����+ �O <br /> TENANT BUSINESS NAME /� COMTACT FOR PERMI Q.],S' SL b <br /> ht �F� 1 �� l• •- a\Q'l PhonUEtnei�lv ��� T0.4�e A1 '.�"� �dN�a <br /> BUILDING PERMIT APPLICATIO'1 ConTrUCT PRice oF woRK <br /> Existinp Use of Building n HEAT SOURCE: <br /> Proposed Use of Buiiding 'LBk�1( � 1 Gas Etennc otner <br /> Building type: _Singie Family _Dupkx_Townhouse _Multi-Family _Canmercial <br /> Typeoiprojed: _New _Addition _Remodel _Repair�T.l.'t Sign_Sprinkkr_Demolition_Change ofUse <br /> DescriplionofWoAc(additionalspacBproviaeConlhe6ack): /,�(.� n�,��tu,y �q(� ��QW �'���..k�jV.�� .� �"1- <br /> hC.w i1'l�ti�a:{ItcL ���t"cy,�'�tt.�: � -� <br /> Have you started workinp without a parmit7 _YES �NO <br /> MECNANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> TypaotProJect: ,_Naw_Addn _Altantlo�_R�p�lr TypeolProJact: _New_AAAn _Altaratlon_Repalr <br /> Show NumAar i ol!lxfures Show NurnMr o1/Irtums <br /> AIC-airhandlin units Toilet <br /> � Forced air s stems Balhtub <br /> Gas i in Lavato waah basin <br /> Water healer I Shower <br /> � Gas fire lace Kitchen sink 8 dic osaf <br /> Gas ran e Dishwasher <br /> Clothes d er ClotAes washer <br /> Ran e hood Water heater <br /> Ezhaust lan Sink urvice/barlrt�o letc. <br /> Heat um Backflow reventer <br /> Unit heater Urinat <br /> Boiler Drinkin Fountain <br /> Refri eration Floordnin <br /> WooCstove Grease tra <br /> Dudin Roof drains <br /> � Olher Medical Gas <br /> SPRINKLER/SUPPRESSION SYSTEM aner: <br /> Number of Heatls Other: <br /> I hereby certily that I have reatl an0 ezamineE this appliwtion and knowlhe same to be Ime anA correcl.All pmviaions ot laws an0 orOinances goveminp <br /> this type ol work v.ill be complied with wfielher speulie0 herein or not.The granting ol a permit Oon not prcsume to qive authorily to violale or cancel <br /> ihe provisiop oLaoy other atate o re mg n ction or the peAormance ol wnstruction.Thet I am authonze0 by t�e o�ner of lhis property <br /> to peROrm the v.nrk r which pliw� n de anA 1 mply �Ih the Stale Contractora Law 1817 RCW en0 298TOO WAC <br /> \I �I � �� <br /> OwnerlAWhodzed Agent Signature Dale (Revised7/2017) <br /> �a <br />