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PERMIT APPLICATIOfV <br /> - BUILDING/MECHANICALIPLUMBINGISIGNISPRINKLERIDEMOLiTION <br /> CITY OF EVERETT PERMIT SERVICES <br />�'* 3200 Cedar SL, Everett,WA 98201 -425-257-8810—FAX 425-257-8857—www.everettwa.org <br />�'"�,_ � APPUCATIONS ARE ACCEPTED FROM 8 AM TO 4 PM G �-I �/�-I Z_ <br />'�'���!".i P OPE7NTA%k PERMITq - <br /> SITE AQDRE S• ���GL,- � D( D�UD D L 2 � ��' � L� <br /> ' DI lSi <br /> LEGAL lor new conslruction: Short PlaVsubdivision Lol No._ (altach copY of long legal daScnD�ion) <br /> OWNER Q.l,�'�(/(�� (. �'���'t�Y PhonelE-mail �.Z`J -:��J%'��•�� <br /> Atldreu �� ' l (S�l � � �(.�� CiryiS�atelZip C �v, !-� �l"i 2�L��`1� rO��O <br /> CONTRACTOR � ,L . . � Cj �� � ,��7Il� i1YU L&I Lic.# ��.0 J � I J <br /> AOaress 1 �i I �� l ��t(��F�n In�� . f) ' �l i _�� (^ PhonelEmail �J�'� -c✓ ��J`��� <br /> TENANT BUSINESS NAME CONTACT F\OR 1PERMI7 ��5 a� C)- I.��I�-��� �� <br /> Phone/E�mLa1if �_JV-I-' -J�i�-V�(��' �rx����"i��, ��'�� <br /> — . BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK �-f'�f�Q[`7 <br /> ' Existing Use ot Building ' P`� �C4'�-fi 2� yH�EAT SOURCE: <br />, . PrOpoSEd US¢of Building '�+' `J'i����'����LF' Gasl�, Electnc_ Other__ <br /> �,:� � Building type: �Single Family _Duplex_Townhouse _Mulli-Family __Commercial <br />,��c�^'; Type of projecL _New �Addition _Remodel _Repair_T I._Sign_Sprinkler_DemoliUon_Change of Use <br /> a°!� DeSUiptiOn Of WO�k(addi(ional spaco provided on fhe Dack�: �, — <br /> � p,��n�, �«�� ��ty-�a�. -+� 5�., „� �-��- f�, .,��-� <br />.:,�..i��-1 ��< c�t-t' iCr�L. �.'„ i�� Y- \/ <br /> Have you started working wllhout a permit7 _YES �NO <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATIOtd <br /> Type of ProJact: _New__Addn _Altorotlon_Rapair Typo ot ProJect: _New_Addn _Altorallon_Repalr <br /> Show Number(p)01�xtures Sbow Numbe�(k)ol/Ialures <br /> � A/C-airY�andlin units � Toilel <br /> Forced air s stems Balhtub <br /> Gas pi in I Lavato (wash basin) <br /> Water heater Shower <br /> Gas freplace Kitciien sink 8 disposai <br /> Gas ran e Dishwasher <br /> Clothes d er Cbthes washer <br /> Ran e hood Waler heater <br /> ' � Exhaust fan � Sink service/badmo /elc.) <br /> Heat pump � Backflow preventer <br /> Unit healer Urinal <br /> i Boiler Drinkin Fountein <br /> Refri eration Floor tlrain <br /> Woodstove Grease trap <br /> Ductin Roof drains <br /> Olher Medical Gas <br /> I SPRINKLER I SUPPRESSION SYSTEM Other. <br /> Number of Heods Other. <br /> I hi�reby cortify Ihat I have read and e�Camin.. '.his opplicalion antl know lhe same l0 60 lrue and cortec4 All provisions ot laws and ordinances Soveming <br /> this lype of vrork will be complieC vnjti�Math�r speciliad herein or noL The granling ol a Dermit Eoes r.ol presume to give aulhonry to vialate or cancel <br /> the pr ision ol any Wtfe)state w�ocal la�regulaling constmclion or lhe pedortnance of construction.Thal I am authonzed by the ovmer o�thi,pwpeny <br /> to D lhe v.ar or whi p calior��s made and I compry with Ihe State Conl2tmrs Law 7827 RCW and 296200 WAC <br /> / <br /> �� �' � // �Q � <br /> ' � Dato /Remsed 2201 f) <br /> e uthod[9d ���e <br /> v <br /> . ... ' i � <br /> , -- <br /> _.__ .� s�o� <br />