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PEkMIT APPLICATfON <br /> BUILDINGIMECHANICAL/PLUMBING/SIGN/SPRINKLERIDEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett,WA 98201 -425-257-8810—FAX 425-257-8857—www.everetlwa.orgn <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM 3 � �7� v�� <br /> SITEADDRES : PROP�7AXN OI PERMIT,p ,�' I <br /> O 'd <br /> LEGAL for new consWction: Short PlaVsubdivision Lol No._ (attach coOY a�long legal desctlptlon) <br /> OWNER y'f�/ f` l�.t'f�-- 'Nn Phone/E�mau <br /> AAdress y63 o V �1-W Y/ i` City/State2ip Q,� <br /> CONTRACTOR S �\I WS L 8 I Lic.# S{M B <br /> Aadress ;� .�''N L. ��Y YU�1� � honelEmail -I�� �J(� 3Z <br /> TENANT BUSINESS NAME Z CONTACT FOR PERMIT �C� <br /> �Q� � 3�W�7 Cs`7_ <br /> PhonelE�mail � � ��.� N�� � <br /> BUILDING PERMIT APPLICATION coNTw+cT PRICE OF WORK O�GbO U'` MC.A � <br /> Ezisting Use of Building r C���rcT/'" HEAT SOURCE: <br /> Proposed Use of uilding �Y�+�xl - Gas_ ElectY.: Olner <br /> Building type: �Single Family _Duplex_Townhouse _Multi•Family _Commercial <br /> Type of project: _New _Addition .�Remodel _Repair_T.I._Sign_Sprinkler_Demolitio�Change of Use <br /> DesGfiplion ot Work(atltl fional space prov/detl on Ihe bac�:T1��' I N� c�J/ s`l � d f- �-�1'�Pv h/�—' <br /> 1� 1' J ( lo <br /> �?tncY �t��( ✓1� v2�� Sq �'�" � ytj✓'a��'� <br /> Have you slarted warking without a permit9 _YES _NO <br /> MECFIANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> TypealProJect: _New_Addn _Allerallon_Repalr TypoofProJecl: _New_Atldn _Alleratlon_Repair <br /> S�ow Number(N1 n�Rtlurcs Show Number(M1 0//lxtures <br /> AIC-airhantllin uni!s Toilet <br /> � Forced air s slems Bathtub <br /> � Gas pipin � Lavelo wash basin) <br /> ( Water heater Shower <br /> � Gas fireplace Kilchen sink&dis osal <br /> Gas ran e Dishwasher <br /> Clolhesd er Clotheswasher <br /> Ran e hood Waler heater <br /> Exhaust fan Sink(servicelbadmo /elc. <br /> Heal pum Backflow revenler <br /> Unit healer Urinal <br /> Boiler DrinAin Fountain <br /> Refri eration Floordrair, <br /> � Woodslove Grease�ra <br /> � Ductin Rooldrains <br /> � Other Medical Gas <br /> SPRINKLER / SUi'F'RESSION SYSTEM Other: <br /> Number of Heads I Other: <br /> I here�y certiy thal I have matl antl examined this application and know tho samo to De true antl correct.All pmvisions ol laws anE ortlinances goveming <br /> this NPo ol work witl be wmpliea vnt�whether specifed herein or not.The g�anling ol a Dermit dces nal presume to Bive authority lo violale or carr_I <br /> the pmvision ot any other slato or local law regulating conslruction or Ihe pertortnance ol conslmction.That I am authonzetl by lhe rnrner ol Ihis pm{�rry <br /> to pedorm tha rk for whic�ap cetion Is matle and I compN)a�h t�e Slale Contrecton Law 10.27 RCW a�d 298.20.^�WAC <br /> , ' _ 3 �� iz <br /> Owne/ hb gent naturo Date (Revised 7/2017J <br /> � <br />