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� � <br /> PERMIT API�LiCATION <br /> BUILDING/MECHANIC^.�/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SER�'ICES <br /> 3200 Cedar St., Everefl, WA 98201 •425-257-8810 — FAX 425-257-8857 —�ah•nv everelhva org <br /> APPLICATIONS ARE ACCEPTED FROM 8 S.'d TO 4 PM <br /> SI7EAODRESS: • i PFOPERTYiA%p GHrt1ITa <br /> ' 3� 2� � ln� A� � � v� . -Ob <br /> LEGAL Icr new consimclron Shod PlaUsu�aivsion tot t!o_ (attach copy cl lonr:C,al Ces.iphco) <br /> OWNER 5(�� wCl�S�--� PnonME�ma�i y"z5 S�2 y6 � � <br /> r <br /> �de�ess (2 1 1 �( a�� v a�r�siaterzp � v v�e'l'�' L.iA 9r�Zo� <br /> CONTRACTOR i�W/�(/ L 31 Lic.�! <br /> nd�ress P�onNEm�! <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> PnenclEmtil <br /> BUILDING PERMIT APPLICATION CONTRACT PRICEOF WORK <br /> Ezisting Use of Omlding _ N[AT SOURCE�. <br /> Pwpose�l Use of Bmlding Gas__ E�ecl��c____ O��a• <br /> �wld�ng lype: �C Single Famiiy _Duplea_Town�ouse _Idull�-Family _Commercial <br /> Type c1 pro�ecf. _New _Atltl�tion _Remodel _Repair_TJ._Sign_Sprinkler�Demol;tion_Change of Use <br /> Descl,piion of Work(aCmbonal spare Frovitledan fnc Da:A): y,� /^ � <br /> wC W4�� 1'� rPr�o�.< +� ftii>> Co1,�5C +for� o" � Pro(�r� � � <br /> Havc you started�vorking wilhout a permit7 _YES � NO <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type o�Projech _New_AAtln _Alleratlon_Repair Typo 01 ProjecC _New_Atldn _Nleratloit_Repalr <br /> Show NumDer(aJ ol lirtures Sbow Num6cr(^l af lirtures <br /> NC-air handl�n9 units Todel <br /> � Fmced a�r systems Uathtub <br /> Gas pioing Lavalory(wash basin) <br /> � Wa�ef heBiCr � ShOWCf <br /> I Gas 17eplace Kdchen sink S tlisposal <br /> Gas ranqc Dishwashcr <br /> Clolhes tlryer Clothes washcr <br /> Rangc hood � Walen c�atcr <br /> Eahaust lan � Sink(service�bndmopletc) <br /> Heat pump Backfiow preventcr <br /> Unit healer U�inal <br /> Bo��ler Dnnkinq Fountain <br /> Rcln�cration Floor drain <br /> � Woodstove GreaSe Uap <br /> � Dudir.q Roold�ams <br /> � Olher Mediwl Gas <br /> SPRINKLER /SUPPRESSION SYSTEM Otncr. <br /> Number ol Heads I Other� <br /> I here�y cerUry I�at I hwC read ana eMamined ihis applmapon and kncw I�e same t0 be Ime anC correcl.Ail prnvis�ens c'Iaws anC cia�nanus gmermng <br /> Ih�s rype of worh�nll be complied vn10 v:hetne�sPeciGCC�crcin or nol.TTe graniing oi a Ocrm�t tlocs not pre5ume lo give aul�oc(y Io�.iolale a�in:cl <br /> Ine pmvision ol any otAer stBle or IOWI law regulaling constNqion or l�e pe�ormance of conslN<lion. That I 0m aul�ontea oy Ihe w+rer cf P��.;prepfi!y <br /> Iu ger'orm Ihe xurk for�:hmh app��calien is made an01 compiy xith Me Stal�Conlractor5 La�v 1B 17 RCW and P98 200 WAC <br /> ��-- ;.� S 1 9 �Q�2 <br /> OwnerlAuthntlretl Agent Signalurc Date (Fewse,l7rzOtr) <br />