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� <br /> PERMIT APPLICATION <br /> BUILDINGIMECHANICALIPLUMBINGISIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar Si., Evereit, WA 98201 -425-257-8810- FAX 425-25i-6857-w�vw•everethva.ory <br /> qppLICATIONS ARE ACCEPTED FR6NI 8 AM TO 4 PM <br /> Jn�t pROPERTYTA%N PERMIT# I <br /> �_ot�� SF3 CotC �rti✓rSE � n'3st� �ilsovzoo �- <br /> LEGAL for nex�ccr�;tn:c:i^n: Short PIal/subdivision�i�-���2 0 0 K Lot No._, (atlach copy ol Iong iegal des:ription) <br /> Phon�-mail y 2 5- 3 N K �`! �S <br /> oWNER SoNN t�'�r� R p C R-- <br /> Address � U l I S (� �<- t�, � R S � CBy/StatelZip {�V�2F_1T � � � �2 6 <br /> CON1'RACTOR F�1 L-l� . � en r7T t I,'�T F S R 'L L 8 I Lie.# F1 Lt,C t,C. 4 � <br /> nddress �r15 Z7 N f-_ (r71,S. �°-t � E�m o N I� R R�5 Z PhonelEmali z 5 -'>`I Ir -3 0 9 <br /> TENANT BUSINE55 NAME <br /> CONTACT FOR PERMIT <br /> PhonelE-mall <br /> BUILDING PERMIT APPLICATION coNTRa,cT PRICE oF WORK <br /> HEAT SOURCE: <br /> Ezisting Use of Building_ <br /> Gas_ Eledric_ Olher_ <br /> Proposed Use of Building_ <br /> Buildingtype: _SingleFamily _Duplex_Townhouse _..,Multi-Fami�y _Commerdal <br /> Type of project: _New _Addition _Remodel _Repair,_T.I._Sign_�prinkler_Demolitfon_Change of Use <br /> Description of Work(adlitional space provided on fhe 6ack): <br /> �inrna� e <br /> Have you staAed working without a permit7 _YES _NO <br /> MECHANICAL PERMIT APPLICATION <br /> PLUMBING PERMIT APPLICATION <br /> TypeofProJoct: _Now_Addn _Alteralion�Repair TypeofProjeet: _New_Addn _Alteration_Repair <br /> Show Number(#)oi(ixfures <br /> ShowNum6c�(#)o/fixtures � Toilet <br /> A/C-airhandlingunits — Bathlub <br /> � Forced air syslems — � ' Lavatory(wash basin) <br /> � Gas piping — Shower <br /> Water heater — Kitchen sink&disposal <br /> Gas fireplace — Dishwasher <br /> _ Gas renge — ( Clothes washer <br /> Cl�thes dryer — Water heater � <br /> Range hood — <br /> — I _--_--- - --.------—5ink(service/barlmoP/efc,l---- . <br /> - ----- -I- " Backflowpreventer <br /> - �Exhaust an���-�--�-�---�- <br /> Heat pump � Urinal <br /> � Unit heater � Drinking Fountain <br /> � Boiler Floordrain <br /> Refrigeration Grease trap <br /> Woodstove — Roc!drains � <br /> _ Ducting _ — Medical Gas � <br /> Other — <br /> SPRINKLER ! SUPPRESSION SYSTEM ,_ other _ <br /> Number of Heads — <br /> I hereby certify Ihat I have read and examined this application and know the same to be Irue and cortecl.All provisions uf lac:s and ordinances govemtng <br /> this type of work wlll be complied with whether speGfed hereln or not The granting ot a permit does not presume lo give aulhanty to violate or cancel <br /> to peAorm the v�nk for whsch`appiication�is made and I complytwifh lheh5 2te Cont act rs Lawt Bc27 RCW and 295 20D WACY tne owner ot this property <br /> 1 � (� Mp� t �_ ( 1'V/ /� � �'�� (Revised 7220f0) <br /> �nerlAulhorized Agent Signature <br /> Date <br />