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I <br /> PERMIT APPLICA.TION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKL�RIDEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett,WA 98201 - 425-257-8810- FAX 425-257-8857-v�nvw.everet a.or <br /> APPLICATIO�i3 ARE ACCEPTED FROM 8 AM TO 4 PM / <br /> SITEADDRE55: PROPERivTAfta PER T/ <br /> o ��J (c�s� ��c, ��� a Z ��.:; r zo3 v�� <br /> LEGAL for ncw construclbre Shoh PleVsubdrvislon__ Lol No._ lellech copy ol long legal descnption) <br /> OWNFR � �I�� ��L�� I I✓��IC����`I Phone/E-meil - LI.7l.' • rj:J�'O `� �QL <br /> Addresa jA��1.C� 6��iC7���!��G a�Yis�aiarzia . �C�G2 ' VvA `-7�' Z1��' <br /> CONTRACTOR ( C A�l ('1� �8 � L10� # ����� �� � ��� <br /> naeres I�� �z i� cC�1 �`�' -#1 � �f A �(��-� =5 Phone/Emeil L,Z� Z`�� I�S��-- <br /> TENANT BUSINESS N ME CnNTACT FOR PERMIT J - 'frL} <br /> .J(�ZZ (g�lill.11l �Zh Z5� <br /> Phone/Emeil <br /> BUILDING PERMIT APPLICATION CON7RACT PRICE oF WORK ���� <br /> Ezisting Use ol Bwlding 0��i HEAT SOURCE: <br /> Proposed Use ol8uildinq Gas Eleclric Other <br /> Buildin7lype�. _Single Family _Duplez�Townhouse _Mulli-Family _Commerclal <br /> Type ol project: _New _Addition _Remodel _Repair_T.I._Sign_ Sprinkler_Demoli�ion__Change of Use <br /> Dtscription of Wodc(etlCdional speca provided nn fha beck): <br /> � t��1� I I ��rj N�r��� ���,�� n1 ����r�� <br /> Have you atartad working wlthoul e permll9 _YES �NO <br /> MECHANICAL PERMIT APPLICATION PLUMBINC pERMIT APPLICATION <br /> TypaolProJect: Naw_Addn _Allorallon_Ropalr TypaofProJo�t: _New_Addn _Alterellon_RepHr <br /> Show Number(xJ oI/i+ture� Show Number(MJ ol I!-'•nes <br /> A/C-eir handlin units 1 oilet <br /> Porcetl a�r s stems Bathtub <br /> Gas ipin Levato (wash basin <br /> Water healer Shower <br /> Gas fire lace Kilchen sink 8 dis osal <br /> Gas range Dishwasher <br /> Clothes dr er Clathes washer <br /> Ran e hood Water healer <br /> Ezhaust lan 5ink semceroarlmo /etc. <br /> Heal um Backllow reventer <br /> Unil heater Urinal <br /> Boiler Dnnkin Foumain <br /> Refngeration Floor drain <br /> Woodstove Grease trep <br /> Duclin Roof drains <br /> Other Medicsl Gas <br /> SPRINKLEk I SIDPPRES310N SYSTEM Other: <br /> Number of Heads _ Othec <br /> I hereby cedity ihel I heve�ead and exemined thls eDPlicalwn end know I�a snme to De Irue anA cortect.All provisions ol lawa end o�tlinencet goveming <br /> this lype ol wo i �e comp vnlh whet�ar speclfed herein or nol Thx pranli�ol a parmit dces not piesume to piva aulhotlly to vb�eta or cancel <br /> �he provision o Y othei stel�local lew r ing constraction or Ihe perlormence ol construdlort Thet I em eulhodzad hy Ihe ovmei ol lh�s property <br /> lo o Ihe work M whirh appl allon le ade a d I com y wilh Ire Slete Conlrecwra Lew 1827 RCW and 296.200 WhC <br /> . i� I� � <br /> Own Authodz AyantSlgn�tu Date (ReviserJYt0f1/ <br /> �i <br />