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F�ERMI�" APP�ICATIO�1 <br /> BUILDINGIMECHANICALIPL6JMBINGISIGN/SPRINKLER/DEMOLIi'ION <br />�rt��;F;_, ;, CITY OF EVERETT PERMIT SERVICES <br />-�^w��; 3200 Cedar St., Everett,WA 98201 -425-257-8810—FAX 425-257-8857—www.everettwa.org <br /> �,y, ��; APPUCATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �J`" �f -'%l <br /> �• � SITEADDRESS• PROVERTYTAI(M _ ? ��TK �- - <br /> I �' � . <br /> %LL, � I�. Si C .,c,(�F{ 1� � `t5' �C L' i iL-c: ;'� cr; \ � � � <br /> - LEGAL tor new construdion: Shon PoaVsuDtlivision �ot No._ (altaU copy of bng legal tlescnption) <br /> OWNER .) �C�- ���-� �"'� Phon�JE-mail <br /> aaaress y''t�`i L rr rlv;�w �l v�. c�ryisiaie�z�p �= v;_�c_f( ,s.\ �l f _u 3 <br /> CONTRACTOR l l3 �. L 8 I Lic.it <br /> Adtlreas Plwne/Email <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT {;:. , � . •��:�. s <br /> _3(L Ai-�"it. 3i•^ Sa. i. . .. i. , - � . , . <br /> '1 - - • j 11\��), �� ��� Phone/E-mail `}Zi-GSZ- � )�"7 i.���:n,�..r.�. !: �' . "' ..t <br /> BUILDING PERMIT APPLICATION coNTaacr PRice tlF woRK v v� � <br /> Existing Use of Duilding 1� �- �; � ���� <<- �� - � HEAT SOURCE: <br /> Proposed Use of Building '�-'�� I,• ��,��„��,�;;�,_{-,. � _ Gas Elecmc OUer <br /> Building type: _Singie Family _Duplax_Townhouse _Mulli-Family _Commercial <br /> Type of projed: _New =Addition _Remodel _Repair_T.I._Sign_Sprinklei_Demolition�Change of Use <br /> D25diptiOnOfWOlk(atlditionalspaCeyoviaedonlheDackJ: (�i`,T m°�', 1.+�. {�."ic:`�� '��. ��..��� � �.°�: ��, r.�• � <br /> < n 27' �i� �. nu,.,�� ; t•- <br /> E' � <br /> Have you started wo!king without a permlt7 _YES �NO <br /> MECHP.NICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATIOH <br /> Type af PtoJecL� _New_Addn _Altoratlon_Ropalr Typo ol ProJect: _New_Addn _ Alteretlan_Repalr <br /> ShowNumber(N)offlrfuras ShowNumDer MJo/Oatures <br /> A/C—alr handlinq units Toilet <br /> Forced air s steTs � BatMub <br /> � Gas ipin Lavato wash basin <br /> Water healer Shower <br /> � Gas fireplace Kitchen sink 8 dis sal <br /> Gas ran e DisF,washer <br /> Clothesd er Clotheswasher <br /> Ran o hood Water heater <br /> Exhausl tan Sink(servicelbadmo /etc. <br /> Heat um Backllow revenler <br /> Unit heater Urinal <br /> � Boiler Drinkin Fouotain <br /> � Refn eralion � Floor drain <br /> Wootlstove Grease tran <br /> DuIXin ' Roof drains <br /> Olher Mediu,i Gas <br /> SPRINKLER f SUPPRESSION SYSTEM Other: <br /> � Number of Heads Olher: <br /> I hereDy cerliry Ihat I�ave read and eaaminetl this applicaiion antl knowiha same lo De true aM conect.All provisions ol laws anC ordinances goveming <br /> this type of nak will be complietl wflh wfiet�er specfied nerein or nol.The prenlirg of a pertnit tices frol presume to gNe authonry to vic'ate or wncel <br /> t�e provis�onqf any oUxy state or local law regulating construclron or the partortnence ol consuuCwn.TTat I am auttwrizeE by the ovmer al lhis properry <br /> ro perlwm 1ry��o!k toc4.n1U eppi�u3lion is matle and 1 comply with ihe Stste Contractors Law 1827 RCW anC 290200 WAC <br /> : ,�J/ . /,�. <br /> v` /i�%.' �"��n ���y <br /> ;�,/'% r , <br /> OwnaflAu4rtdzed Agent Slpnatum Oale (RevisedY20f t) <br /> I/� <br />� �_ __ __ ___ �c_ _ . — <br />