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� � i <br /> PERMIT APPLICATION <br /> BUILDINGIAAECHANICAUPLUMBING/SIGNISPRINKLERIDEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett,WA 98201 -425-257-8810-FAX 425-257-8857-ewnv.everetMa.org <br /> APPLICA710NS ARE ACCEPTED FROM 8 AM TO�PM <br /> SITEADDRESS: vRoa[ntti� U( OO � �S— <br /> ET7Yb <br /> LEGAL Iw neN construaion: Short PlaVauhdiNsion Lot No._ (ettach copy o1 kxig lepal desuiption) <br /> OVYNER �E�i� W � l PhonelE-mail �2./�8 IC!�O [ <br /> Atldress City/StelelZip � <br /> CONTRACTOR l — L&I Lic.# N 9� <br /> naaress �C'� N�1 U ('D ano�man - <br /> TENANT BUSINESS NAME CONiACT FOR PERMIT Q�� p��cu�� <br /> /VTv <br /> PhorielE-mail Z 77 � <br /> BUILDINGPERMITAPPLICATION coNiRncrPRlcEOFWORK � <br /> ExisGng Use of Building HEAT SOURCE: <br /> Proposed Use of Building Gas E�ecvic Other <br /> Butlding type: �,Singie Family _Duplex Townhouse _Muiti-Family _Commercial <br /> Typeofprojecl: _New _Addition _Remodel Repair_T.I._Sign_Sprtnkler_Demolilion_Change ofUse <br /> DescriptionofWofk(additionalapaceprovidedonfhe6acW; �EQ�� ��Sn�/� ��.�_ S�yul(CE <br /> M�"'t I�'t�7�x- 'TD h��sE i /N� Gci/[L gc $o,e��+� T7-i6 sE�Vrc'F. <br /> Have you started working wlthout a permlt9 _YES �NO <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> TypeofProJect: _New_Addn _Alteretlon_Repalr TypeofProJect: _New_Addn Alteration_Repair <br /> ShowNumber p o/llxtures ShowNumber # o/flxturea <br /> AIC—airhandlin uNts Tollet <br /> Forced air s stems Bathtub <br /> Gas I ing levato (wash basin <br /> Waler heater Shower <br /> Gas tire Iace Kitchen sink&dis osel <br /> Gas ren e Dishwasher <br /> Clolhes d er Clothes washer <br /> Ren e hood Weler heater <br /> Exhaustfan Sink servicePoadmo �etc. <br /> Heat um Backtlow reventer <br /> Unit heater Udnal <br /> Boiler DAnkin Fountain <br /> Refri eralion Floortlrain <br /> Wood�tove Grease tre <br /> Ductin Roof Oreins <br /> Other Medical Gas <br /> SPRINKLER/SUPPRESSION SYSTEM Other. �-� �/L�//� <br /> Num6er oi Heeds Other: <br /> I hereby certify thal I have reaC and examined this epplication end know the same to be We end correU.All provlsions tl:lews end ordinantes povemirp <br /> this type ot v.nrk vAll 6e complied wiN wheNer spedfied herein or nol The pranlinp of a pertnit dces not presuma to pivr:e�RMrity to vblate or cancel <br /> / lhe pravision ot�1y other sWte or loca�law repulalinp tonsWclion a the performance ot oonsWctlon.iTet I em eulha�ed by Ihe ownM of thla property <br /> \ to perform �il�w Ac for which eppli� � Is �deau I compy vAth Ne Sta Con ctors Lew 78.27 RCW end 296.Z0�WAC <br /> ,.� 8"��o lv <br /> OwneB ponlSlgnaW Dat (ReWaedYtOfi) <br />