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c , <br /> PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 -425-257-8810—FAX 425-257-8857—www.everetlwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM 7 �I �I ( <br /> SITEADDRESS: PROPERTYTA%M PE MIT O�_ D� <br /> Zq U�Yr�P�c ��. U� IT 1� � <br /> LEGAL br new wnstrucbon Snon Piausuoaroision iot No (attach copY ol long legal deunplion) <br /> OWNER PnTRic� D• C�L�-'Sa� pnone�E�mail HZs-5s3-iro6 ch�Fd���?►a>n�;/, o� <br /> Atldress Ce�oZ� ULYh�(C �R. vNt f /� City/State2ip fV��CLI'l W� �1$2�3 <br /> CONTRACTOR ��y�L /1ti�N• L 81 Lic.# /''�T I`� 1 O IC <br /> aaress G�y� �Sj�� A��, Sfk1T�-E W/� Phone/Email 2�` -Stv - 3SY� <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT�^,�.`i� ����N <br /> N�A Phone/E�mall 415 543•+�0� chcf.dcw�� lwiht��.c <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of Building �ESt L E�i 1Al_ HEAT SOURCE: <br /> Proposed Use o(Building S��"�'E' Gas_ Eiectric Other_ <br /> Building type�. _Single Family _Duplex�Townhouse _M�Iti-Family _Commercial <br /> Type of project: _New _Addition _Remodel _Repair_T.I.�Sign_Sprinkler_Demolition_Change of Use <br /> Description ot Work(atltliliona/space pmmdea on(he bacA): <br /> AI�D PIPin1G FRor� Gx�57iN� M�ETfR Ta NEw FRLESTi�N�i,✓G F��,�ct, <br /> Have you started working without a permit7 _YES �NO <br /> MECNANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type ol ProJeck _New,r,Aetln Alleotlon_Repalr Type ot ProJxL _New_Addn __Alteratlon_Repelr <br /> Show Nw:ber(N)ol/IMures Show NumDer(N)o/Ilxfurcs <br /> AIC—air handlin unils Toilet <br /> Forced air s stems Bathtub <br /> Gas i in Lavato wash basin <br /> Water heater Shower <br /> Gas fire lace Kitchen sink 8 dis osal <br /> Gas ran e Dishwasher <br /> Clolhes d er Clothes washer <br /> Ran e hood Water healer <br /> � Ezhaust fan Sink servicelbaVmo /elc. <br /> Heat um Backflow reventer <br /> Und heater Urinal <br /> Boiler Drinkin Fountain <br /> Refri eration Floor drein <br /> Woodstove Grease tra <br /> Ductin Root dreins <br /> Other Mediwi Gas <br /> SPRINKLER / SUPPRESSION SYSTEM Other: <br /> Number of Heads Other: <br /> I hereby certity I�at I have read antl examined Ihis apPlicahon and know Ihe saine to�e Ime antl correcl All provisions of laws antl ortlmances goveming <br /> Ihis type ol xoik will be comDbed wdh wheiher Specdietl herein or nol The graM�ng ol a permlt aces nol presume to gwe aulhonty to vblate or fancel <br /> the pmvis�on ol any other slate or local law regulahng con5lrucUon or the peAom�anu!ol construc�ion That I am authonle0 by Ihe owner of Uis properly <br /> lo Oerform Ihr wp�k tor �Ch a�¢a6on is made and I ccmply wiih Ihe Slaie ContrettOrs Law 18 27 RCW an0 296 200 WAC <br /> ��/� ,-%� � ���' �� <br /> Owner/A "fi¢ A�e blgnatu�e Dale �Rensetl7/2077J <br />