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� <br /> f ? ( �� � ��� � � ���� � <br /> `.t ✓ �,p <br /> PERMIT APPLIGATtON <br /> BUtLDING/MECHANICAUPL.UMBINGJSIGNISPRtNKLERfDEM�LITtON <br /> CiTY OF EYERETT PERMtT SERVECES <br /> 3200 Cedar S#., Everett, WA 982t3't 425-257-8810 FAX 425-257-8857 www.everettwa.org <br /> SITE ADDRESS: � PROPER t x�a Q R # �� <br /> LEGAi.for new construction: Shoft PlaUsubdivision Lot No. (attach copy of tong fegai description) <br /> OWNER � Phone/E-mail . . <br /> ddres � Cityl5tate/Zip <br /> APPLiCANT:�Owner _,Owner's Agent ontractor ,_,_,Contracior's Agent „^Tenant emun a�o�ao a�eno�or��se��r�vm tne ow�,e��o ao wor�+��ne sPece� <br /> CONTRACTOR State lic.# Cit Bus.Lic.# <br /> Address Phone�Email �-( '� <br /> T E��! �f��� CONTACT FOR PERMIT �n�� ��,. �^ <br /> l..V ��D 2����d <br /> ��`j`���� � �(`, ��� Phonet6-maii � CL <br /> __. _. <br /> BUfLD1NG P IT APPL CAT10N CONTRACT PRlCE OF WO <br /> �cisting Use of Buiiding HEAT SOURCE <br /> Proposed Use Of Building Gas Electric Other <br /> �: <br /> Building type: ,.,_Singie Fami(y �4uptex�,,,Tawnhouse _,_,Muiti-Fami(y Commerciai . <br /> T e o# ro'ect: New Addition Remode{ Re air T.1. S' n S rinkte Damolition Chan e of Use <br /> DESCRIPTION OF WO+�`�ddrtr na�spacs provided on fhe back : ���� � t <br /> ' �'1�l� 1 �'�.b'l I.t��-�l �c1�„'�i� �� Gt�N�.S�' <br /> t E� <br /> 2- s. `� � <br /> F`� <br /> MECHANICAL PERMIT APPLICATION � � <br /> a� " <br /> �h... �w <br /> e of Project: _New,_Addn _,Alteration,_Repair Type of Project: _,New�Addn _ Iteration_Repair <br /> Show Numker � of flxtures Show Number # nf flxtures <br /> AiC—air handlin units Toilet <br /> Forced air s stems � Bathtub <br /> Gas i in ! Lavato wash basin <br /> Water heater Shower <br /> Gas fire lace Kitchen sink&dis osai <br /> as ran e Dishwasher <br /> Ci es d Clothes washer <br /> Ran d Wa#er heater <br /> Exh t � Sink servicefbaNmo /etc. <br /> H t urrs Backflow reventer <br /> nii heater Urina! <br /> go�{efi Drinkin Fountain <br /> Refri eration Floor drain <br /> � Woodstove Grease tra <br /> Buctin Roof drains <br /> Other � S� <br /> SPRINKLER/SUPPRESSION $YSTE Other: <br /> Numbe►of Heads Other <br /> I hereby certify that I have read and examined this appiication and know the same to be true and correct.Ail provisions oi iaws and ordinances govemi�g mis rype of work wili be comp <br /> with whether ifisd herein or not.The granting of a permit dces not presume to give authority to vialate or cancei the provision of any other state or lacai law regulating construction <br /> T t i am au ed hy th owner of this ro rty to pertorm the work for which application is made and t compty with the State Convactors Law 18.27 RCW and Z96.200A WAC, <br /> • "' �' , 1i., <br /> oriz gent Signature Date ��,l,�� `(��) (Revised 9i2074) <br /> 4� 6 � <br />