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� � <br /> PERMIT APPLICATION <br /> BUILDINGIMECHANICALIPLUMBINGISIGNISPRINKLER/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 /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITEADDRESS: I ' �V � • PROVER7YTAxN PE IT�I <br /> '�u��S 5zo�i6�o ���RrNT wf. 48�� OOb�i 24'10l loo //U� ' �' <br /> LEGAL lor new wnsWdion: Shorl PlaVsuEdivision Lot No._ (attach copy ol long lepal tlescriplion) <br /> y lD . I9�Jb li <br /> OWNER/Ap,pt�� t£Qi E F.(�r'� Phone�E�maii 4�25 •258-Yat2 <br /> adress qllv PaC.�fli� p�/E CirylStale2ip ���QG�'t , w�'' ag�Z�O <br /> CONTRACTOR T�- �• L&I Lic.# � <br /> ddress — PMnelEmail ' <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT f¢p1.lt,�S V IVVP SLwlO(Z� <br /> p(bJ�vE�� �utOu.Mi 'CCaOD�U+�*�S/425-T7$- iS3o <br /> �,/��pl�pfli ��.I' t�(L PhoneJE-mail �VII.LA OR� ��• `qµ <br /> BUILDING PERMIT APPLICATION CON7wncr PRiCE oF woRK E-K• 3 � °O°' �� <br /> Exisling Use of Building �0��'��`-'�� 9L� HEAT SOURCE: <br /> Proposed Use of Buildingµ����' ��� �'� Gas Eleclric Otner <br /> Buliding type: _Singte Fami�y _Duplez_Townhouse _Multi•Family �Commercial <br /> Type of project: _New _Addition ✓Remodel _Repair_T.1._Sign_Sprinkler_Demolition_Change of Use <br /> D^Suiption ot Wotk(addifional space{xovlded on fhe backJ; ��� ��tP�,.�GK'r <br /> 6u.t�9 �oUT c= A (p,3oo sP JO•5��,4R�M+D �^'ou'��7 e�'P� <br /> ;.I.ILLIli JFl 'ME GJ2H Q��� OF �OJlO�?'hfLEC.-nOaP�li M��Uu-Mi �f..-�f't2 �s <br /> ,ul�9lvGa. Oi�Trl�-�c.. '�U.tvDt�6( <br /> Have you started workii�g without a permlt4 _YES _NO <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type ol ProJect: _Naw_Addn _Alteretlon_Repalr Type ol ProJxt: _N�w_Addn _Altention_R�p�lr <br /> Show NumDer(M o!/Ixtures Show NumDer )o/flxtuns <br /> AIC—airhandlin units I Toilet <br /> Forced air s stems Bathtub <br /> � Gas i in Lavato (wash basin <br /> � Water healer Shower <br /> I Gas fire lace Kitchen sink&dis osal <br /> Gas ran e Dishwasher <br /> I Cblhes d er Clothes washer <br /> I Ran e hood I Watar heater <br /> � Ezhausl fan Sink senicelbar/mo letc. <br /> Heat um Backflow revenler <br /> Unit heater I Urinal <br /> Boiier Drinkin Fountain <br /> Refri eration Floordrain <br /> � Woodstove I Grease tra <br /> I Ductin I Roof drains <br /> � Olher � Medicat Gas <br /> SPRINKLER /SUPPRESSION SYSTEM I Other: <br /> � Number of Heads � Other: <br /> 1 hereby certiy lhat I have reatl and examinetl lhis application and know ihe ume lo be true and correcl.All provisions of Iaws anE ordinances Boveming <br /> Ihis type ol work will Ee complietl with w�et�er specified herein or not.The granting ot a permil dces not presume to give authority to vblate or cancel <br /> t�e provision of any other slale or local law regulaling construction ar lne perlormance ol eonslruclion.That I em authorizeA by Ue a.mer of lnis properry <br /> to pedorm the vrork br whic0 application is metle an0 I comply with the Slate Contrectors Law 18.27 RCW and 298100 WAC <br /> �G�nc,e,� �(,QQ�o�J 8-o¢-aori <br /> Ow IAulhorl=eU Agenl Slgnalura Dale (Revised 7/2017) <br /> �/a <br />