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i <br /> I <br /> PERMIT AFr"LICATION <br /> BUILDINGIMECHANICALIPLUMBINGISIGN/SPRINKLERIDEMOLITION <br /> CITY OF EVERETT PERMIT SERVICE5 <br /> 3200 Cedar St., Everett,WA 98201 -425-257-8810—FAX 425-257-8857—www.everetlwa.org <br /> pPPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITEADDRESS: lo(�. /_�V� 1 L� � PROPERNTA%N P MIT /� � <br /> W J <br /> LEGALfornewconslructian: ShorlPlaVsubdivislon - <br /> Lot No._ (attach copy al iong legal descnption) <br /> OWNER -� � £ vic.�O�« ���� Phon�lE�mail HtS - 3�'1- �3"� <br /> Address �p12 l �""� � Y�� CitYlSlalGZip c��CJ-.A};- . � �Zo <br /> � ` L81Lic.# <br /> CONTRACTOR �� � '-- L _ �y I <br /> {-H RJ� � P�onelEmail Z� " <br /> Address 2 \� CON7'ACT FOR PERMIT <br /> TENANT BUSIN SS NAME . <br /> PhonelE�mail <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK_ I-7 D O <br /> 4iEAT SOURCE: <br /> Exisling Use of Building <br /> Proposed Use of Building Gas_ Eleclric_ O�her_ <br /> Buildingtype: _SingleFamily _Duplex�ownhouse _Multi-Family _Commercial . <br /> TypeofproJecl: ✓New _Addition _Remodel _Repair_T.I._Sigrt_Sprinkler_Demolilion,_Changa o(Use <br /> Description of Work(additional space provlded on fhe 6achJ: �/�w 9y��,���� � �5(,,, �I <br /> �K \ <br /> .'�/{�.Vy°S wA2'C.f �`c'.�.�`�( (V�'S�1\ <br /> Have you started workfng wilhout a permit7 _YES _NO . <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERIAIT APPLICATION <br /> TypeolProJect: _New_Addn ._Alterallon_,Repalr <br /> TypaofProject: Now_Addn _Alteretlon_Repair ShowNumber(N)a�lixtures <br /> Show Num6er/N1 of Ilxfures Toilel <br /> A/C-airhandlingunils i� Balhtuo <br /> � Forced air systems � Lave'�(wash basin <br /> Gas piping � Shocaer . <br /> Wa�er heater <br /> � Gas freplace � Kitchen sink 8 disposal <br /> . Dishwasher <br /> Gas range Cicthes washer <br /> Clolhes d er W,;ter heater <br /> Range hood Sink(servicefbar/moplelc.) <br /> Exhaust fan ' <br /> Healpum B�;ckflow revenler <br /> Unit heater Uilnat <br /> Boiler D�-inking Fountain <br /> Refrigeration Fioor drain <br /> � Woodstove Grease trep <br /> � Ductin R�ofdrains <br /> � Other Medical Gas <br /> SPRINKLER/SUPPRESSION SYSTEM Cther. <br /> Number of Heads I Olher: <br /> 1 hereby cetlify thal I havo read and examined this application and knmv the 5emo to 6e lrue and wrrect.All provisions of laws and oNinances goveming <br /> this typo of work will be wmplied vrilh whelher specified herein ar not.Tho granting of a permil does net presume to give aulhority lo violate or wncel <br /> the provision ot any oNer sleto or Iocal Iaw regulaling wns�ruclion or the pedormanca ol conslruclion.That 1 am a�thonzed by l�e owner of this properry <br /> lo pedorm ihe work whlch application I ade and I wmpty with lha Stale Conlraclar Law 18.27 RCW and 293.200 WA': <br /> ..� � �p�l�L- <br /> , � � <br /> l � (Revised 7/20f f) <br /> 0 erlAuthorized Agent Signature DaTe <br />