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� <br /> PEF�MIT APPLICATION <br /> BUILDINGlMECHANICALIPLUMBING/SIGN/SPRlNKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 -425-257-8810— FAX 425-257-8857—wn^:,v.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITEADDRESS: I�ry ��� ^�„ r� ��C,��,/IA(�pyG+ PROPERTYTA%p PERMI7� <br /> `� ��«L JC w a`•�� � OS�4LL7�0.2�100 L����- <br /> LEGAL for new conslmction: ShoA PlaUsubdivision��Q�( � �H^� Lol No.� (allach copy ot long le9al descriplion) <br /> OWNER P�,�/�li�j� CO/yl/r1UNi�S PhonelE-mail (�ZS3�Sk�'� I�IL/ox/D�� <br /> Address �1Q,�S LPo.�(�N �/J� 5Ui i�F CilylStalelZip PLJL f�L1.U�° C��1t ��'3�-� <br /> CONTRACTOR pP.fJh i�2 comrn�Ni ri�S L&I Lic.# I'2�m��i �l67T(r <br /> n^ rC (253)8�l8 l4uo Kto�! <br /> Address ��d1.5 �A����v tW �� �(.1�„ � PhonelEmail mJ�vlan�/u[ {C�/hi ",1 �Ytil h tt� <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT , r-"� <br /> mfi2 jKF u�4N s�cf'/�c m�cinsNclui <br /> Phone/E-mail (�S3 SNSiuuD�/o� (eitL�m�t�n? �� <br /> BUILDING PERMIT APPLICATION CON7RACT PRICE oF WORK <br /> Exisling Use of Building /J�/� HEAT SOURCE: <br /> ProposedUseofBuilding I1V1�1 S-F' �PSi���/1CC Gas Electric_ Oiher_ <br /> Building type: �Single Family _Dup�ez_Townhouse _Mulli-Family _Commercial <br /> Tvpe of project: �New _Addition _Remodel _Repair_T.I._Sign_Sprinkler_Demolition_Chanae of Use <br /> Descriplion of Work(addifional space provided on fhe 6ack): , L I � <br /> �atS;r.�c;i� er � a��,� sr ���nfNc� 5��, ��r <br /> Have you started working without a permit7 _YES X NO � Z2 � <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> TypnofProJect: _New_Addn _Alteration_Ropalr TypeofProJecU _A^w_Addn _Alterotlon_Repalr <br /> Show Numbcr(pJ o/lxtures Show Nw:iber(M)o/�z ures <br /> A/C-air handling units Toilet <br /> � Forced air systems Bathtub <br /> j Gas piping Lavatory(wash basin) � <br /> � Water heater Shower <br /> Gas firepl2ce i Kitchen sink&disposal I <br /> � Gas range � Dishwasher <br /> Clothes dryer � Clolhes washer <br /> Range hood Water heater <br /> Exhaust fan Sink(service/bar/mop/etc.) <br /> Heal pwnp BackFlow preventer <br /> Unil heater Urinal <br /> Boiler Drinkin Fountain , <br /> Refrigeration Floor drain I <br /> Woodstove Grease trap �. <br /> �, Ducling ?i Roof drains � <br /> Other Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM Other: <br /> � Number of Heads Other: <br /> t herehy certify Iha[I have read and ezainined Ihis application and know the same to be Irue and conect.All provisions ol laws and ordinances governing <br /> this�ype of work riill be complied with whether specifed herein or noL The granting of a permit does no�presume b give aulhoriry�o violale or cancel <br /> Ihe pmvision of an olher state or local law regulatiny constmction or Ihe performance of consiruclion.Thal I am aWhoiized by Ihe owner ol lhis propetly <br /> lo ped m t wo (or which application is made and I comply wilh the Stale Conlrac�ors Law 18.27 RCW and 296200 WAC <br /> �U � � � � ��%�����v ��I(>��� <br /> wn /Aulhor zed Agent Signature Dale (Revised�011)I/ <br /> a <br />