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PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett,WA 98201 -425-257-8810—FAX 425-257-8857—www.everellwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TQ{FM <br /> SIIE�DDRESS: PROPER7VTA%N PE MITM ^_v�.er <br /> � u J m e � ar 5lJ <br /> LEGAL lor new conslrudlon: Shoh PlaVsubtlivislon Lot No._ (allach copy of bng lepal descnp�lon) <br /> OWHER f � '� J a G✓ PhonelE-mail <br /> CEress �� � G h�Or�- /QJt. Ciry/SIaIe/Zip ��/G��-� W � p�.,(� <br /> CONTRACTORA a.•� 1{r<< �� "f,1+ f oaf;. �ycL&ILic.lt <br /> ddress Q�- r. S L• c c+tn� S��SY P�one/Email 21' � �(dV <br /> TENANT BUSINESS NAME CONTACT FOR PERMIi <br /> P�one/E-mail <br /> BUILDINa PERMIT APPLICATION CONTrucTPaICEOFWORK fHfvo - <br /> ExistingUseoBuiltling R�����'-cc. HEATSOURCE: <br /> Proposed Use ol Building Gas Electnc Omer <br /> Building type: _Single Family �Duplex_Townhouse _Multi•Family _Commercial <br /> Type of proJect: _New _Additian _Remodel _Repair_T.I._Sign_Sprinkler_Demolition_Chenge of Usa <br /> Description of Work(addifional space provideJ on Ihe 6ack): <br /> RC�O�aGt q 4Ca5 �r+nnac <br /> J <br /> Have you started working without a permit? _YES _NO <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Pro)ect: _New_Addn ,�Al:eratlon_Repalr Typa af ProJect: _Naw_Addn _Altaretlon_Repelr <br /> Show Number(N)o!Ilaturet Show NumAer(XJ o/flrfurea <br /> A/C—airhantllin units Toilet <br /> l I Forced air s slems I Bathtub <br /> Gas i in I Lavato wash basin <br /> � Water heater Shower <br /> � Gas fre lace Kitchen sink 8 dis osal <br /> Gas ran e Dishwasher <br /> Clothes d er I Clothes washer <br /> Ran e hood Water heater <br /> Exhausl fan Sink servicelbar/mo /etc. <br /> Heat um BackBow reventer <br /> Unit heater � Urinal <br /> Boiler Drinkin Fountain <br /> Refri erelion Floordrain <br /> � Woodslove Grease tra <br /> � Duclin Roof drains <br /> Olher Mediwl Gas <br /> $PRINIQIER I SUPPRESSION SYSTEM Other: <br /> � NumberofHeads ( Other: <br /> �here�y cerlily that I hava read anU e�amined this application and know Ihe same to be We and wrrec�.All pmvisions ol laws anE orEinances goveminp <br /> Ihis lype ol xrork will be complied wilh w�eiher speciGetl herein or nol.The granling of a permil dces nol presume to give authonty�o violate or cancel <br /> Ihe provision ol any ot�er etate or local law regulaling wnstruction or the pedortnance ol consirudion.That 1 am auihorizetl by t�e owner ol t�is pmperty <br /> to pertorm I�e work lor whic�application is ma0e and I comply vnth I�e State Contradors Law ifl27 ftCW and 288.2�0 WAC <br /> C�u+� ,E' ��l� �i?.Z/^���,/ <br /> OwnerlAulhodzed Agent Signatura Date (ReNsetl 9/20ff) <br />