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( ( <br /> PERMIT APPLICATION <br /> BUILDINGIMECHANICALIPLUMBINGISIGNISPRIN KLERIDEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett,WA 98207 -425-257-8810-FAX 425-257-8857-www•everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM — '� <br /> SITEADDRESS: PROPERTYTHI(R PERMIT• _ <br /> 3 _ 2 t�oo I 000 <br /> LEGAL lor new consl�udion: Snort PlaVsuhdivision Lot No._ (atlach rnpy ol b�p k9al Eescription) <br /> OWNER Phone/E•mail 2 U�Tl..• � <br /> aaress 31�f , MAPJ CirylState/Zip �E E,-�-i q ( <br /> CONTRACTOR I.HAe.TC-� U5 UC-'71 OIV L 8 I Lic.N <br /> ddress �(�(J J N 2A1Ey S Jl�.-QTTLE �/�J ���� PM�/Email �ZO�o" C��-' I�IO� <br /> TENANT BU INE NAME CONTACT FOR PERMIT^'��SE I N Ft%�-� <br /> Pnonere-maa � 3 t333 0� •� �f-�E <br /> BUILDING PERMIT APPLICATION coNrrucTPRICeoFwoRK �o � <br /> Existing Use of Building �J�� HEAT SOURCE: <br /> Proposed Use o1 Buiiding Sf Q-- �'��STn!(�- Gas Ekctric Otner <br /> Buiiding type: V�Single Family _Duplex_Townhouse _MuRi•Family _Commercial <br /> Type of project: _New _Addition �ftemodel�Repair_T.I._Sign_Sprinkler_Dertwldion_Change of Use <br /> DeSCriplion of Work(additional space provitled on tM1e back): <br /> S� �$ nG� �1 n o-C <br /> Have you atarted working wilhout a pertnit4 _YES OLNO <br /> MECMANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Typa ol ProJect: _New_Adtln _Alteratlon o'�it"epair Typ�ol ProJeet: _New_,Addn _AlNnllon_RpNr <br /> SAow N�mDar(Nl oI/Irturas SAow NumMr(N)of fl+tuns <br /> AIC-airhandlin units I Toilet <br /> � Forced air s stems I Bethtub <br /> Gas i in I Lavato wash basin <br /> �� Wa[er healer Shower <br /> Gas fire lace I Kitchen sink 3 dis sal <br /> i Gas ran e I Dishwasher <br /> Clothes d er Clolhes washer <br /> Ran e hood Weter heater <br /> Exhausl fan I Sink(servicelbarl etc.) <br /> I Heat um I BackNow revenler <br /> � Unit heater I Urinal <br /> � Boiler I Drinkin Fountein <br /> � Refri eration I Floor drain <br /> Woodstove I Greasetra <br /> Ductin I Root drains <br /> '� Other � Mediwl Gas <br /> SPRINKLER/SUPPRESSION SYSTEM I Other: <br /> � Number of Heads I Other. <br /> I hereby cetliy lhat 1 have reatl and examinetl ihis application and know lhe same to De tme anE cwrect.All provisions of laws antl orCinances qavertAn9 <br /> Ihis type ol work will Ee complietl witn whelher spetified herein or not.Ttie g2nting ol a pefmd does not presume to qive authoriry lo vblale or wncN <br /> ihe provision ol any other state or local law regulaling consiruction or Ihe peAortnance of wnslruction.Thal 1 am authorize0 by tM owne�al t�is propertY <br /> to pedorm lhe vrork for which appliwtion is matle and I compry vrilh I�e Slate Conlradors Law 18.27 RCW antl 296.200 WAC <br /> /KL+-y"� �(�_L'' (RevisCd7/20fi) <br /> OwnerlAu d entStgnature Date <br /> I/2 <br />