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PERMIT APPLlCATION
<br /> BUILDING/MECHANICAL/PLUMBINGlSIGNISPRINKLER/DEMOLITION
<br /> CITY OF EVERETT PEftM1T SE"�VICES
<br /> 32(.0 Cedar St . [verett, WA 98201 -425-257-8810-FAX 425-257-8857 -www everettwa org
<br /> APPLICATIONS ARf:AC�EPTEU fROM 8 AM TO A PM ��I � Z
<br /> SITE ADDRE55: PROPERTV TA7f� PERMIT t r..
<br /> ',;� ,� ' 1 , �.' ,OSiqc�^��o�CCU :) 2G � U
<br /> I EGAL Ior rMw c�ri5lrii�Yiun >hn�l PiaV��dwUv���nn 1 at tk� Ial�;vh ropy d long I[ga�OracipM1o��!
<br /> OWNER i� i i� � 2N r:�� „�� � � s:�. �� ,,.��,MR..n,��
<br /> nan,ess .[� � _�c�� oi�;si,ie2�o pcL[E�uL- (.ti� (� S'��(,1 1
<br /> CONiRACTOR �� `,; r.., ,.� L811icp '".�I�CL;.;; �, ..�yLD
<br /> �.�o,l )4q���' r�
<br /> AdAn155'1 l' �� �J � � . • 1. , � i �r��� '�t r i � VhOnnihnu�i 1: �11 � -,��i'�'
<br /> TENANT BUSINESS NAME CONTACT FOR PERMIT
<br /> 1'.�` 11< .,. � , .�i,� ,�, �,.t; . , .`
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<br /> . ' Pn,�nr�l- ��a�� � 4 3 ; �3 � •( � •�:`I a
<br /> DUI:.DING PERMIT APPLICATION CONtRACt PRiCE oF WORK_ +�`t___1;�___
<br /> �Exislmg Use ol flud4ing_ l�� ,• ���i .__�'�_____ ___ HC-l1T SOURCE
<br /> PrGpr,s�d Usc ol 13uddmy (:nh Fkctir. Oih��r
<br /> OwiJr �type _Single Family _Duplex_Townhouse _Muth�Famdy ✓anmeraal
<br /> Ty�•�.� I+o�ect __New _Additian _Remodel _Repan_T I _�gn___Spnnkle� __ DemuSuon___Change nl U�c
<br /> �.�iscr�pti�',n nl WorM(,arMdrrriai sn,xr nmvr„e.f nr!hc dx.Fl 1
<br /> � � , � . �i ,i1�...... �i5�1 : �i . ,-�� �>I�'�-'� { .;�.1 �:.:� �.,
<br /> Hava yo��eUrt�v;working without a permit7 __YES _��HO
<br /> MEf�l1A1�LILAL PERfAIT APPLICAI'ION PLUMBING PERMIT APPlICATION
<br /> ly{.. ol ProJrcl ✓ I�rw _AAdn __Alle�nbon ___Repnn Typr nl Prn�ecC _New_AAdn __Allnrelion _Repnir
<br /> __ 5 now No� �rr(/J o/(hfures _ Show Numbn(/)o/lirt�ucs _ _
<br /> ti�(. -Bif I1Bf1(11Tf3 U01�5 T011f�
<br /> FOtCM�dR 5 SICrt15 F72lhlllb
<br /> Gi> �pin l.avato (wash bas�nl
<br /> Wa�er heater Shower
<br /> Gas hreplacc Kitthen smk 8 dis sal
<br /> Gas range Dis�washei
<br /> Clothes dryer Clothes washer
<br /> Range hood Wale�neater
<br /> Exhaust fan Smk�serv�celbairmo lelc �
<br /> Neal um backllow preventei
<br /> Unit heater Unnal
<br /> 6otler Drmkm Fountaw
<br /> Heln iauon Hoor dram
<br /> Woodslove Grease lrep
<br /> Duct�ng Rool A�ams
<br /> OUier_�1(� _ Medi�al Gas
<br /> SPRINKLER / SUPPRESSIOPI SYSTEM Otlier
<br /> Nurnhrr ol Headti Othef
<br /> I hr,vby irqAY Ih.il I hnve rr;e7 m�d ci.�ninevllh�s r.M4u.Oa�and uar+tfu�sante Io bB '�u08M cnrte!G All prOri5iIX15 0l laws anA�xJ�nanCeS Vavcnin�
<br /> ,i.��,hf�of xak�II6c comphe0 wrtn whether s�xr.ihe�1 here�n o�rrot Thc gianOng of d x�*ut Ooes rrot pesume m grve a�.itn,�.�r, �.,��..i.cr�r�ar� ��i
<br /> p,..�xnv�vm of»ny o1hM slNr w�ual liw irpulatrtq�mnsiru;�ip�or Ihe{�pYo�marxx ol�onshUction lhal I am aulha�ze�]1� 7•r,�.n �ri,.,�,�.s p�,��•,�ty
<br /> � ,v•�1orm V+e vrtHk kx wh�rn;�iqA�c�iron is made ana I u�nMy�+Ui Ihe S13te Co��baclors Law 18 77 RCW end 79f 200 Y���'
<br /> ��_L � ��'S'�2
<br /> Owrv.r�Au;nnrvn•il A�I�•i��Siqu.divi . .�.� �:,,� sr�l.'.'n••.
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