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NERMIT APPLICATIO(V <br /> BUILDINGlMECHANICALIPLUMBINGISIGNISPRINKLER/DEMOLITION <br /> CIl"Y OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., EvEarett, W<�°8201 - 425-257-8810—FAX 425-257-8857 —www.everet?wa.org <br /> APPL.IC.4TIONS ARE ACCEPTED FROM 8 AM TO 4 PM ,3�- a-� �/ <br /> SITEADDRESS: � PROPERNTARN � PEfjMIT# <br /> Icx,�ll I�} D2i�� S� 2�c� ,t� ,IU,��I , �3 -00� <br /> LEGAL lor new construction: Shon PlaVsabdivision�Il[��h��E'1�� !�t�LQ.�2.. Lol No.� (attach copy of 1on91e�a1 descnption) <br /> �• ` �. , <br /> J � � �� �$�S.{J u� . n ' � <br /> OWIJER (,L/�/1�1,'� N�r,4i�.G.l','1}- Phone/E-mail M�li�.< < -� ,- ��S �_ l�(�/�' Aic . lu3 <br /> Addiess�t��5 lQ,`� LvA {�C� ��St�. /" Ci�ylSlatelZip � ' (C(,(,�;,' �(.�� `IC�-��� <br /> CONTRACTOR �(�J�11�L2 �U`L.FI'�LJQ,�r L 81 Lic.# L�A%����AN`i V_I 3 �T <br /> Address�z�'S C�t��yo� r'�� L, yi �^ �i�<<Il�+�� L��n �7�''�>> PhonelEmail �Sh��w���A �S�iUdCcG LCti'iJ2�.� ��9 <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT mR�, �J ke �nN j j j ('ttt�- <br /> �(S3",9L "11c`� <br /> PhonelE-mzil fn �''4� 'AN ���H�L �L(=:t.'l�i�.�' CiYl�l <br /> BUILDING PERMI'i APPLICATION coNTRaC7 PRiCE oF WORK <br /> Existing Use of Buitding �i I !�� HEAT SOURCE: <br /> Proposed Use of Building �}(!(� 1 S t�' �l(' 4�( l Pn [l Gas 7L [lectric_ Cther_ <br /> Building lype�. �Single Family _Duplex_Townhouse _Mul�i-Family _Commercial <br /> Type of project: �New _Addilion _Remodel _Repair_T.I._Sign_Sprinkler_Demolition_Change of Use <br /> DesCriplion of Work(addrtional space pmvided on the backJ: ^'� <br /> tion <br /> �O r15f 2L�C l�a'� C� cl /Lt:t,J S� %��(�1L/�CL ���s � � <br /> Have you started working without a permit7 _YES _NO <br /> MECHANICAL P'ERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> 7ypo of ProJact �New_Addn _Altoratlon_Repair Type of ProJnct: ,y�Naw_Addn _Altnration_Ropalr <br /> Show Number(kJ o(/ixtures Show Namber(tt)ol lixtures <br /> � NC-air handling units � Toilet <br /> Forced air systems �) Ba�htub ' <br /> � Gas piping � Lavato (wash basin) <br /> Water heater � Shower <br /> i Gas fireplace Kitchen sink 8 disposal <br /> � Gas range I Dishwasher <br /> � Clothes d er I Clothes washer <br /> Range hood Waler heater <br /> Exhaust fan Sink(servicelbar/mop/elc.) <br /> Heal pump Backflow preventer <br /> Unii heater Urinal <br /> 6otler ('� Drinking Fountain <br /> -5 Re(rigeration Floor drain <br /> �,� Woodstove � : � Grease irap <br /> Ducting ;"S Roof drains <br />� � � Other � Medical Gas <br /> SPRINKLER I SUPPRESSION SYSTEM � " Other: <br /> �� � � Number of Heais Other. <br /> i <br /> I hereby certity that I have read and examined Ihis apptication and kno•.v Ihe same to be Irue and correcL All provisions of laws and ordinances governing <br /> Ihis type of work will be complied wilh whether speciGed herein or noL 7he granting of a permit does not presume to�ive authonty to violate or cancel <br /> Ihe pmvisinn of any other slate or local law mgulaling conslmction or the pedorman:e of constmction.That I am aulhorized hy the owner of this propetly <br /> to perfo the work for which applicalion is made.nd I comply wilh Ihe State Contractors Law 78.27 RCW and 296200 WAC <br /> ' , , ��i511�-. <br /> � � <br /> OwnedA,u lorize i Sl9naturo Dale jRevised22077) <br /> V �� � <br /> '__ _ _ ��� <br /> � <br />