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' � ( � <br /> PERIVIIT APPLICATION <br /> BUILDINGIMECHANICAUPLUMBINGISIGNISPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett,WA 98201 -425-257-8810-FAX 425-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM!AM TO 4 PM <br /> SITEADD ESS: PROPERriTAIIN PERMITIt <br /> •3z - au ���w,z. ��+rt.�C��'I�. 4isao� oo a�s Zooi7oo -02 <br /> LE6AL Ior�w a :truction: Short P1aVsubOivision La No._ (attaU ropy ollonq Iepai tlescnption) • <br /> OWNER Oi"L��' V'�'1li �� �i"` PhonrlE-mail �.�wri� 6� t41.�1t a'tat'L'A'D� � � S' • �Nt <br /> Odress Zg� {y� �tUli , , V7 Ci�Y/51atUZip �.�(?.1"� vy� la�� <br /> CONTRACTOR �"J N�i:rL-G3'I LI�Ns tQ (16N� (N�- L&I Lic.M SY�E G.71 b(J <br /> aaress�'41�b �iFi � 1� � 0 1V���G (�1+� 9�i�IZ PhonNEmail �}j$ �3��".5�� <br /> TENANT BUSINESS NAME (� CONTACT FOR PERMIT Q.]S 3 SL b <br /> hi k��7'L/'�� 1�+='J\Q.�.LI P�onUEtnai�lV �l� 1'0.4�c� C A�' C � �dNa <br /> BUILDiNG PERMIT APPLICATION CONTRACT PRICE OF WORK Z <br /> Existing Use at Building HEAT SOURCE: <br /> Proposed Use of Building �Pka1� 1 l Gas eiectnc Otner <br /> Buildingtype: _SingleFamily _Dupkz_Tmvnhouse _Multi-Family _Commercial <br /> Type ot projed: _New _Add'Rion _RemoCel _Repait�T.I.�Sign_Sprinkler_Demoiition_Change of Use <br /> Desc�ipti0no(Wotk(addAionalspacQprovi0edonfheback): �(., n�,��L�y A� �l�� C��`,.k��,� .� c'I..�S'�. <br /> —\ 1 <br /> h�.w Y{'L�L�u;{(tst ��t"aw''Ka�: � <br /> Have you staRed working without a parmllT _YES �NO <br /> MECNANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type ol ProJact: _Nsw_AOtln _Allarrilon_Repalr Typa ol Proj�et: _!Nw_AdAn _Alqntlon_Rap�lr <br /> S�ow Number pJ o!flxturof Show NumMr o/Hxturos <br /> AIC—airhantllin unRs Toilet <br /> � Forced air s stems Bathtub <br /> Gas i in Lavato wash basin <br /> Waler heater Shower <br /> I Gas fire lace Kilchen cink 8 Eis osai <br /> Gas ran e Dishwaeher <br /> Cbthes d er Clothea wesher <br /> Ran ehood Waterheater <br /> Exhaustfan Sink urvicelbarlmo letc. <br /> � Heat um BadcBow rcventer <br /> Unit heater Urinal <br /> Boiler Orinkin Fountein <br /> Refri eration Floordrain <br /> Woodatove Groaee tre <br /> Dudin Roof Ereins <br /> � Olher MeOical Gas <br /> SPRINKLER I SUPPRESSION SYSTEM aner: <br /> Number of Heads Other: <br /> I hereby ce�ily that I have rea0 anE ezamina0 lhis appiication anE know Ihe same to be irue anC cunect.All provisions ot�awa anC ortlinancee qoveming <br /> Ihis type ol work vnll be complieE vnth xfielher specitied herein or not The granting ol a permit does not presume lo yive authonty lo vblate or wncel <br /> ihe provisi�ola�y other slate r re ��g n ction or Ihe pedormance ol construdion.Thal I am aulhonzerl by l�e rnmer ol lhia property <br /> lo dorm the work r wfiich pliw� � ae antl I mply �th the State Contra�ors Law 1827 RCW an0 298200 WAC <br /> �� 1� l (I <br /> OwnerlAuthotlzed Agent Signature Dale (RevisedY2011) <br /> �a <br />