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oiioe/zaiz rnx e� 3o rax _____PJooi/o0z <br /> . <br /> PERMIT APPLICATIOiV <br /> BUILUING/MECHANICAUPLUMBING/SIGNISPRINKLER/DEM�L4TION <br /> CITY OF EVERETT PERMIT SERVICES ( (oj i� <br /> 3200 Cedar St., Evarefl,WA 98201 -425•257-8810—FAX 425-257-8857 —wwv+.evere a. rg <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITEADDRESS: /_�! ' PROVER1YTAl(N PERMITM � _ <br /> 11O S� 0 00 <br /> LEOAL b� ,�uw constmcllort Snorl PlaVwbElvltlon lol No._ (ellerJ+mDY of Imp leqel deecnpUa+) <br /> OWNER � Phone/E�mell �� 3 <br /> AdOroes W `aJ�nO K� �IJ� pry/Slat✓Lip �1 /'� � � 1 <br /> CONTRACTOR GY� � L d I Llc.N RE <br /> AUdrase aCj 5• S .� q �a Fhona/Email z,Q{p� <br /> T[NANi B SINE39 NAME TACT fOR PER I <br /> �Sy,� ��mbtc.�CDX" <br /> Phon&E•mell O — <br /> BUILDINO PERMIT APPLICATION CONTRACT PRICE OF WORK� ��� <br /> Erlslinq Use ol Bulldinp HEAT SOURCE: <br /> Propaaetl Use of BulWinp Ges � [iecuk Olner <br /> Bulldlnp type: _Sinple Famlly _Dupkx_Townhouse ,�Mulll•Famiry _CommerGal <br /> Typa ol pro�ecl: _New _AtlCRion _Remodel ,_Repeir_T.I._Sipn_Sprinklor_Demoll4on_Chenqa ol Uce <br /> DescBption of Work pdelrronai s a proNdee on tn�becx)� <br /> �ns+a,l� 9as �'urnace, �.he�, YLcrtL�O�EmE�IS, 95°io, �o,oao,3-ru <br /> Hav¢you stahed worklnp wllhout�permlt7 _YES ,ZNO <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATlON <br /> Typ�ol ProJect: _N�w_Addn �',AltenUon_Rap�ir Typ�ol Pro��cl: _N�w_Addn _Albntlon_Rep�lr <br /> ShawNum6�rfM of/lafuns ShowNumE�r M ol/Irtures <br /> PJC-eir hanAlln uNls Tollet <br /> Forced alr s stema Belhtub <br /> Gas i in Leveto wash bacln <br /> Water healer Shower <br /> Ges fne lace Kllchen slnk 6 dle osel <br /> Gaa�en e Dishwasher <br /> Clothesd er Clolheawaeher <br /> Ran e hood Wate�healer <br /> [zhaint lan Sink eervicelber/mo etc. <br /> Hoal um BackOow revenler <br /> Uni(heata� Udnel <br /> Bollar Drinkin Founlein - <br /> Relri prallon Floordrein <br /> Woodstovc Oroase Ir <br /> Dudin R0o1 dreMt <br /> Other Medical Oas <br /> SPRINKLER/ SUPPRESSION 8YSTEM other: <br /> Numbe�ollieada Olher. <br /> I heieEy ceniry Rut I heve ieW�M aramined thU eppliulion m0 Mow tM uma l0 6e We end carect.AM prov4bn�ol l�ws�nd admanca�9a+�inp <br /> 1��type d vrork wlll W�omplied Mlh wlwtMr�pecllled hxein or no1 llio 0�����q of�p�rmit doet nal presume lo plve�uUanty lo vld�l�or canoel <br /> IM Provision ol any other qete or lor�l I�w nqulalinp tanelmct:an a tM parlortnrou ol construGbn.Tul I am aulhotlied by ihe avnar d l�4 pnprrry <br /> lo p�Aorm tM A for kh�ppketlon I�made�nd 1 compN�Ui ll��Sttl�COMracton L�w tO.D RCW�n0 28E.200 WAC <br /> /�� /� <br /> O odAuthor oE ABent Slpnatun Dale (ReWsed 7/70/1J <br />