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� �� � �. <br /> PERMIT APPLICATION <br /> BUILDING/MECHANICAUPLUMBINGISIGN/SPRINKLER/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 8 AM TO 4 PM � d�I <br /> SITEADDRESS: ��� , �. D POOR�T�N " �IS-�I�1� -OOZ P/'� //O� D� <br /> LEGAL for new construclian: Short P�aUsubdivision Lol No._ (attach wpy oi lorq lepal descAplion) <br /> OWNER �� ,j j b�2� PhonelE•meil ^ � � r <br /> Addre6s , '�'� � CltylSlale/Zip 1\1 J <br /> coNrw►croR \ �rc `Sk '�n�- L 81 Lic.N CGa 1 �� Ey o <br /> Address �1� PhonelEmeil 4 ZS�va ��rl CG 1( <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Q� PhonelE•meil r7 � V � I <br /> BUILDING PERMIT APPLICATION CON�u►cT PRICE oF WORK / !o <br /> Existing Use of Building b I HEAT SOURCE: <br /> Proposed Use of Building �T� �t71 Q\�X , Gas EledAc Other <br /> Building type: _Single Family �Dupiex_Townhouse _Multi-FanJlv _Commerciel <br /> Type ot project: ,�New _Addition _Remodel _.,Repeir_T.I._Sign_Sprinkler_Demolition_Change of Use <br /> Description of WoAc(edditionel spece provided on fhe baekJ: <br /> dd �p.o�► u^�-t, �^,° �u a� <br /> Have you eqrted working wlthout s permit7 _YES _NO <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Typa of Proj�et: _New_Addn _Altention_R�pelr Typ�ot ProJ�el: _Nwv_Addn _Albntlon_R�pdr <br /> ShowNumber(M oI/lxture+ ShowNumMr o►Brfuns <br /> A/C-air handlin units Toilet <br /> Forced air s stems Bethtub <br /> / Gas i in Leveto wash besin <br /> •�) Waterheater Shower <br /> Gas fire lace Kitchen sink 8 dis osal <br /> Gas ran e Dishwasher <br /> ��. Clothesd er Clotheswasher <br /> Ran e hood Water heater <br /> Exheust fan Sink servicelbar/mo /etc. <br /> Heat um BeckFlow reventer <br /> Uni�heater Urinal <br /> Boiler Drinkin Fountain <br /> Refri eration Floor drain <br /> Woodslove Grease tra <br /> Ductin Roof draina <br /> Other Medical Gas <br /> SPRINKLER / SUPPRE8SION SYSTEM Other: <br /> Number o(Heads Other: <br /> I hereby certify thal I have read and ezamined this Bpplication and know the seme to be tnie and corted.All provialons of lavrs end ordinencea poveminp <br /> ihis lype ol work will be complietl with whether specified herein or not.The granlinp of a permil does rrot presume to giva authorlry to violate or cencel <br /> the provision of any other state or lowl law regu�ating construdion or the peMormance of conslruction.Thal I am authorized Cy the owner ol Mla properry <br /> �o peAorm lhe work Por which appliwtion is made and I comply wilh Ihe Slele Conlractora Lew 78.27 RCW and 298.200 WA� a9 �g � <br /> � , � ,� f I yJ \ <br /> /' ' ; r. <br /> �.v ,C si J ` - � ! R, <br /> OwnerlAuthf�dzedApanl�Signaturo ` Date �R°������� J�� <br /> i� 3� �� <br /> � <br />