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, ' <br /> PERMIT APPLICATION <br /> BllILDING/MECHANICAL/PLUMBINGlSIGN/SPRIN KLERIDEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar SL, Everett, WA 98201 -425-257-8810—FAX 425-257-BB57—wvNv.evereriwa.org <br /> APPLICATIONS AFtE ACCEPTED FROM E AM TO 4 PM <br /> SITEADDRE55: VROFERTY7AKM P MITN <br /> 453 seaw,�. o0 oaoo2 0 � - o 0 <br /> LEGAL lor new mnstrucllon: Snort PlaVsuDOrvision Lol No. (atlacn copy ot long legal tlesc�D�ion) <br /> OWNER ��T' L P�onelE-mail yZ5• 2 U� C (MT• <br /> ada•�ss 500 // R T AYE c+ty�staie2v E 9 O <br /> coNrr�croR fsrqr Es �g����.a Esr�r�lr �y7 /�K <br /> Address ((��CX� I�l/C� GCEEk BLVD �ilE'/2/ M��t c,�eEk 4•K � PhonrJ[mail yZS� 7y3• 33 7 <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT�p�� �(tNE <br /> P�one/E-mail •'j , 1 GIQ��SL S A7 NuMES.NEr <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE Of WORK <br /> Ezisting Use of Building SF R HEAT SOURCE: <br /> Pmposed Use ot Building �G �/�/�l�e __ _ Gas Electdc Otner <br /> Building lype: xSingle Family _Duplex_Townhouse _Multi-Family _Commemial <br /> Type ol project: _New ZC Addition �Remodel _Repair_T.I._Sign_Sprinkler_Demolition_Change of Use <br /> Desuiption of Wodc/ada�uonaispacepmv�ved on ihe bac o� ro REq�e EAsr oF h�ME ,'0�--� <br /> �toDEG OG�E�S« f RDD/T � � • <br /> Have you started worklnp withoul a permit7 _YES �NO <br /> MECMANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type a1 P�oject: _New�Addn �Alterallon_Repalr Type oi ProJxt: _New�Addn X Altention_Repalr <br /> ShavNum6er olfixfures ShowNumDer olpRures <br /> A/C—air hantlling units Toilel <br /> �orcedairo stems 1 Bathtub <br /> 1 Gas i in Lavato wash basin <br /> Waten c�ater 2 Shower <br /> Gas fire lace � Kitchen sink 8 dis osal <br /> � Gas range Dishwasher <br /> Clothesd er I Clotheswasher <br /> Ran e hood Wate�heater <br /> [xhaust fan Sink scrvicclharlmo Ir.tc. <br /> Heal um BackAow reventer <br /> Unit he2ter G a Urinal <br /> Boilcr Drinkin Founlain <br /> Refri cration Floordrain <br /> Woodslovc Grease�ra <br /> Dur.tin Root drains <br /> Olher Medical Gas <br /> SPRINKLER 1 SUPPRE3810N 8YSTEM o�ner: <br /> Number of Heads Other: <br /> I here�y certiy Ihat 1 have reaa and examineU this applicaLon antl Anow the same to be true an0 correct.NI D��isions oi laws anE ordinanres goveming <br /> Ihis type ot work will lre compliM wth wfiether spec�fied herein or not.The granling of a pertnit Gces not presume lo grve authonry to vidale or cancel <br /> Ihe pmvi�ion o y ot r state or lowl law regulaling consWction or Ihe pedortnance ol wnsWction.Thal I am auRionzed by the owner ol lhis pmpetly <br /> lo peAorm�rk� wtnc�appliralion is matle an0 I comply with tha Stale Cqntraclors Law 1827 RCW and 296.100 WAC <br /> �• Z� o�� <br /> OwnetlAut i gnatura Dale (Revised; Ofl), <br /> ��3 `�z <br />