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i <br /> PERMiT APPLICATION <br /> BUILDING/MECHANICALIPLUMBINGISIGNISPRINKLERIDEMOLITION <br /> • CITY OF EVERETT FERMIT SERVICES <br /> 3200 Cedar St., Everett,WA 98201 -425-257-8810-FAX 425-257-8857-w�.vw.evereriwa.or <br /> APPLICA710N5 ARE ACGEPTED FROM 8 AM TO 4 PM �`� � — � Z <br /> vaoveeTv raz r ��T"' <br /> SRE AD�RESS: Q — <br /> � F � �ot No_ (anacn wp/ot lo�e�esat desu�Plion) <br /> LHGAL iar rrewwnsWttion�. SMrt PlaVsuDdivision <br /> • Lq,�,� PnonelE-mail �-/ �`�3 <br /> OWNER ��. � � <br /> earess �7a� Y 8 r � 3 Lc�yisuceza W-►'J ��D <br /> CONTRACTOR t . o��H Iet� L&I LiG.M <br /> ACdress Sb4 i g� �•w � W � �Q hone/Emaii 79 7� <br /> TENANT BUSINESS NAME CONTACT FOR PERMR Q�y` g,�p1'J K' <br /> Phone/E-ma� o �4M �3o(a QW � � <br /> BUILDlNGPERMITAPPI.ICATION CONTRACTPRICEOFWORK <br /> 1 S � +K <br /> � HEAT SOURCE: <br /> Euisting Use of Building � <br /> � Proposed Use of Bullding Gas_ Eieefic� othar_ <br /> Buiming type: X-Singie Family _Duplex_Townhouse _Multi-Family _Commercial <br /> Type of project: 1CNew _Addition _Remotlel _Repair_T.I._Sign_Sprinkler_Demolilion_Change of Us^e "�s <br /> Descfiption of Work(add�7ione!spxe providea on the 6ack): ��t �� i'y� Q w� /V�����5�"�� ��"`�R�� <br /> IJ-c_e.� Pc..�nn.�o `r.�v�do-or Mesd�-f eE �Sk C+��I N R , D.�mr wtu2 v�,� � <br /> Have you started working wllhOUt a pefrtlit? _YES �NO <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> TypeofProjecC �New�,f�ddn �4lteretlon,__Rap�ir TypeofProjact _New_Addn Al(entipn�Repalf <br /> Show Numsoi M9 0!/7xtu�es Show Number o1 tGcNros <br /> A1C—air handli units Toilet <br /> ForCetl aif s stems Bathtub <br /> Gas i ing W�ato (wash basin) <br /> Water heater Shower <br /> Gas fireplace Kitchen sink&tlisposai <br /> Gas ra e Dichw85hef <br /> Clothes dryer Clot.hPz'ra�:ier <br /> Ran a hood WalCf he9tCr <br /> ExhauSt fan Sink(xrvice�barlmopletc. <br /> Heal pump BatkfloW feventer <br /> Unit heater Urinal <br /> Boiler Drinki Fountain <br /> Ret ' era;ion FIoo1 dfain <br /> Wopdstove � Grease trap <br /> Ducting Roof drains <br /> Olher Medical Gas <br /> SPRINKLER I SUPPRESSION SYSTEM othec <br /> Number of Heads Other: <br /> I r,ereby cen�fy that I�eve read and eimmined Mis application ana know me same to he W^and corre:t.All Frovisions oi iaws end ordinances goveming � <br /> mis rype ot v.ork w,q be canp�ieo vnm wnetner spodr�d nere�n or noL The 9�ntlng of a permit does not p�esume to 9�'e aWnortry 10 vio�ate or canCel <br /> Ire prov�von a(eny olher sta[e or local law reguia�ng constructbn or the perlamancs oF wnsvudion.Thal 1 em authaized 6y Ihe owner of this DtoPeM <br /> to pedortn tlie�wrk for which eppic;tion is made entl I mmpry wilh the Slale Contractors Law 19.27 RCW and�6,200 WAC <br /> 1�)�,;.�.• ' ti�;.:�� -7- I'7- Ia <br /> OwnerlAuthari�d Agent Signature <br /> Date (Re✓ised7/1�tt) <br /> z �, �. , c� .,;1 wa�o�� z�oa �<< ���r <br />