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( � <br /> PERMIT APPLICATION <br /> BUILDINGIMECHANICAUPLUMBINGISIGNISPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 -425-257-8810—FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM!AM TO 4 PM <br /> SITE ADDRESS: r� PROPEnTY TAX 11 PER�IT <br /> �_. , <br /> \ O'�-UI � <br /> LEGAL for nevu consinidlon: Short PlaVaubtlivision Lal No._ (atlech wpy oi long legal deaaipllon) <br /> OWNER ('� lJ,�( Phone/E-meil C C'- �'0 <br /> AEAress \ N��J'Q... City/Stale2lp �✓e-� <br /> CONTRACTOR G llA �CLr CkF.� � 61 Lic.N - C <br /> Adoress (� � O2� c�� � Phone/Email - <br /> TENAhT BUSINESS NAME CONTACT FOR PERMIT ,J u+a ut r C�ioh�Cno � <br /> 415 2O5 36�t� <br /> PhonelE-man n0. �1.��N 4 L5 3 <br /> BUILDIN�i PERMIT APPLICATION CONTRACTPRICEOF WORK Q�(,��0 �L.+y <br /> Existing Use of Building b HEAT SOURCE: <br /> Proposed Use of Building �� Gas Electric Other <br /> Building type: 2C Single Family _Duplex_Townhouae _Multi-Famiiy _Com nercial <br /> Type of projed: _New _Addition 7�Remodel _Repair_T.I._Sign_Sprinkler_Demoiition_Change ot Uae <br /> Descri tion af Work(ed0itionel spece provided on fhe Dac�KJ: <br /> I�s�1�.c 2 r.c� s�ltc�l�s , Y�mc,� pa���r� o•� e�c�sh� v�o.�, S1�eA.� Ybt.k. <br /> H�ve you alarted working without a pertnit4 _YES X NO <br /> MECHAPVICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of ProJ�cl: _New_Addn _Altention_Repalr Typ�ot ProJeet: _N�w_Addn _AlNratlon_Rep�lr <br /> ShowNumber(R/o/flrtums ShowNumMr o//lxtuns <br /> A/C-air handlin units Toilel <br /> Forced air s slems Bathtub <br /> Gas i in Lavato wash basin <br /> Water heater Shower <br /> Gas fire lace Kitchen sink&dis osal <br /> Gas ran e Dishwasher <br /> Clothesd er Clotheswasher <br /> Ran e hood Water heater <br /> Exhaust fan Sink servicelbar/mo /etc. <br /> Heat pum BackAow reventer <br /> Unit heater Urinal <br /> Boiler Drinkin Fountain <br /> Rehi eration Floordrain <br /> Woodslove Grease tra <br /> Ductin Rooi drains <br /> Other Medicai Gas <br /> SPRINKI.ER / SUPPRESSION SYSTEM Other: <br /> Number of Heads Other: <br /> I herehy ce�tify�hat I have read and examined Ihis epplication anA know Ihe same to be trve end correcl.Atl provicions ol laws arM oMlnances goveming <br /> ihis type of work will be complied with whether specifed herein or nol.The grantlng of o pertnit dces not presume lo givo aut�ority to violate or wncel � <br /> t rovision of any other slate or local law regulating consiruc�ion or ihe pertormence of conalrudlon.Thet I em authoMzed by the ovmer ol this propeAy � <br /> to p orm Ihe wo fo ich ppli tion is made and I comply with the Slat Co irectors Law 1827 RCW and 298.200 WAC I <br /> �'� � / /� <br /> Own � lhorl antSignature ale (ReviseC711011) <br /> / <br />