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� r_ <br /> PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES �.. 2 3—�( <br /> 3200 Cedar St., Everett,WA 98201 -425-257-8810-FAX 425-257-8857-www.everellwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM —4 <br /> SITE ADDRESS: AROPERTY TAX N RMI7 N <br /> (esoo rYterr�l,l. Cree% f�kc� oJ ci�ro - oz <br /> LEGAL lor newconslruction: Short PlaVsubdivisicn_ Lol No._ (altoch copy of long legal escriplian) <br /> OWNER Q'.�j �j]7L`/G, /� honelEmail 4�.10-3�,5 '77��] <br /> Address�� (/!G�(�G✓ a� JT2 �SZ� Ciry/5tate/Zip �,(..� � <br /> CONTRACTOR N11� L L 81 Lic.# 53 z s� OO ��I <br /> Addross ���(O �J`""7 � e �. q(!O"I'µa lN� ��Z Phono/Email �53^ -IZ�('��pb <br /> TENAnNT BUSINESS NAME CONTACT FOR PERMIT �Q� e VO <br /> /y V 7�.Ch 'I. Ph000�-mei� Z�'248- ZOrF �o�e.�Vo�SKt 1 H+ �/-f. • <br /> BUILDINGPERMITAPPLICATION CONTRACTPRICEOFWORK �02/� /6S C�h <br /> Exis�ing Use ol Building HEAT SOURCE: <br /> Proposed Use of Buiiding Gas E�ectric Oiher <br /> Buildingtype: _SingleFamily _Duplex_Townhouse _Multi-Family _Commercial <br /> Type of proJect: _New _Addition _Remodel _Repair_T.I._Sign_Sprinkler_Demolition_Change of Use <br /> Destfiplion o(Wo!k(addifional spaco provlded on Ihe 6ack): <br /> Hava you started working wllhout a permit7 _YES _NO <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> TypeolPro�ech _New_Addn _Altaratlon_Repalr TypeolProject: _Naw_Addn _Allantlon_Repair <br /> ShowNumber olfixfures ShowNumber(M o//lsfums <br /> I A/C—airhandlin units ' Toilel <br /> � Forced air s stems Bathtub <br /> Gas i in I Lavalo wash basin <br /> I Waterheater i Shower <br /> � Gas Gre lace � Kilchen sink 8 dis osal <br /> I Gas ran e Dishwasher <br /> � Clothes d er I Clothes washer <br /> I Ran e hood � Water heater <br /> Exhaust fan Sink servicelbar/mo elc. <br /> I Heat um i Back9ow reventer <br /> I Unit heater � Urinal <br /> Boiler Drinkin Fountain <br /> � Refri eration Floor draln <br /> Woodslova Grease lra <br /> � Ductin I Rool dralns <br /> ; Other � Mediwl Gas <br /> SPRINKLER/SUPPRESSION SYSTEM I Other. <br /> �p.3 � Number of Heads �� Olher. <br /> I hereby cortily Ihel I havo read and examinad Ihis nppiicetion and know lha same�0 6e Wo end corrad.All provisions of laws and ordinances govaming <br /> this lype ol work riil ha complied xith Nfielhar spocifiod harein or not.Tho 8�����8 0l e pertnil doos not prosuma lo givo eulhori�y lo vidale or cancel <br /> tha provision ol any olher slala or local law rnguiating consWclian or tha porformence of cronslruclion.That 1 am euthorized by the m�ner of this proparty <br /> lo peAo �e� rk 1 r wfiich appliwtion is made nnd I comply v.ith tho Slate ConVec�ors Law 1827 RCW end 296.200 WAC <br /> 1� lr,� 9�,��„ <br /> Ownerl uth edAgentSignature �Date (Revisod?/T017) <br /> t�� <br />