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•�-) • ( <br /> PERMIT APPLICATION <br /> BUfLDINGIMECHANICALIPLUMBINGISIGNISPRINKLER/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 /> APPIICAT10N3 ARE ACCEPTED FROM 8 AM TO 4 PM I�S <br /> SITE ADDRESS: I) {� �� P�ERTVTNt p I S - O _�a PE T/O S - -�� <br /> ��l\5 1�, <br /> LEfiAL for�ew consWction: Short PlaUsubdivision Lot No._ (attach copy o(Ionp kyal desaiption) <br /> OWNER .. \v PhonelE-meil � �� � 'Ty � <br /> Address � �-�� -.� City/S�ate2ip � � o`� ✓ <br /> CONTRACTOR P�\ bvE- C�S-�F� � L d I Lia M G �� OS <br /> Addresn �r111�-- PhonelEmail � �S' � ���1��� <br /> TENANT BUSIN SS NAME CONTACT FOR PERMIT���� �� �Kb'.� <br /> PhonelE-msil N - � -� 7 � <br /> BUJ![.DIN6 PERMIT APPLICATION CONrw�CT PRICE oF WORK�� <br /> IExisting Use of Building N 0 NF\ HEAT SOURCE: <br /> Proposed Use of Building_N41..� �U�F-K Ga� Eledde Cther <br /> Building lype: _Single Femily �,Duplex_Townhouse _Multi-Femily _Commerciel <br /> Type ot projed: �„New _Addition _Remodel _Repair_T.I._Sign_Sprinkler_Demolition_Chenge o(Use <br /> Desc�iptiOn of Wofk(atldilional space yrovided on(ha beck)� <br /> N�,� v,�Q�x �736 5� , �c.�-h <br /> H�ve you started working w�thout a permit7 _YES �NO <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Typ�of ProJact:�� - New_Addn _Altaration_R�pdr ryp�of Pro)�eC Show Numb�rd(A o/BxtunsGon_R�pdr <br /> Show Number(N)oI Rxtures <br /> AIC-airhandlin units Toilet <br /> Forcedeirs stems Bathtub <br /> / Gas i in Levato wash basin <br /> Water heater Shower <br /> Gas fire Iace Kitchen sink&dis osel <br /> Gasran e Dishwasher <br /> _, . Ciothes d er Clathes weaher <br /> � Ran e hood Water heater <br /> �,� Exhaust fan � Sink servicelbadmo letc. <br /> Heat pum Backflow reveMer <br /> Unit healer Urinal <br /> Boiler Drinkin Fountein <br /> Re(ri eration Floordrain <br /> Woodslove Grease tre <br /> Ductin Roof dreins <br /> Other Medical Ges <br /> BPRINKLER / 8UPPRESSION 8Y8TEM Other: <br /> Number of Heads Other. <br /> I hereby certity thal 1 have read and ezamined thls eppllcation and know the seme to be true and cortect.All provislons ot lawa end ordinxnces qoveming <br /> this lype ol work will be complied vnth whelher specified herein or not.Tha prentinp oi e permit doea not preaume to pive aulhorlty lo vlolate or cancel <br /> the provision of any olher steta or local law regulating construction or the peAortnance of construdion.TTat I em aWhorized by tha owner oi thla propetty <br /> lo peAorm Ihe vrork for which ap/p�licalion is mada anA I comply with tM Stete Controdon Lew 78.27 RCW arW 298.200 WAC <br /> l �'"�'�' ��V C�`� ���� � � I� (Revisetl7R01f�� <br /> OwnerlA �or�t6d Agant SIBn�ture � Dale � <br /> � � i'�� <br />