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�ERMIT APPLICATIO� � ���0���� <br />BUILDINGIMECHANICAL/PLUMBIN SI�N PRINK I�/�A�I��9�10� <br />CITY OF EVERETT PERMIT SERVICES PUBLIC WORK� <br />3200 Cedar St., Everett, WA 98201 - 425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FRG'A B AM TO 4 PM I�- o�-D �—/Z <br />E ADDRESS: <br />TAX H <br />0 <br />tt <br />for new construclion Short PIa1/subdivision _Lol No._ (attach copY ol long legal descnp�mn) <br />�. <br />�55 ga9 -�• Q?�t.�T. T,s <br />IANT BUSINESS � IAME <br />q4/-1...> y' .e�.vr.�.�.s <br />NG PERMIT APPLICATION <br />�a <br />& I Lic # .CG/ / 7 7 <br />�1T9 • S� 73 •.j.3o7 3 �c i�y- <br />�9 Phonc/Email(�NN�G DI��MQi6.�s•Ce.�a <br />ONTACT FOR PERMIT �33 • y r3 •3.s.z a% i,)- <br />�O /✓n/ �E Ur/F�C y <br />hone�E-mail CONiYi2 ��is+�GSi6.�/b • t+d.K <br />PRICE OF WORK <br />Exisling Use. of Bwlding .�LTA/[ HEAT SOURCE� <br />Proposed Use of Building�t/,BuiTU,Q d ,�LwiTR e Gas_ Electnc_ OUier_ <br />Bwlding rype� _ Smgle Family _ Dupiex _Townhouse _ Multi�Family X Commercial <br />Type of projecP. _ New _ Addilion _ Remodel _ Repair _ TJ. Zt Sign _Spnnkler _Demolition_Change of Usc <br />Descnpl�on of Work (addiGona� space prowrled on fhe back) �. <br />/N3i i9'�a LI i L�I/ANNE c .�E-77E.tZ <br />.e�9�lw�v mouw.raD �.+�« ��G+-,�.,. - 3G.ao .� <br />Have you started working wilhout a permit7 _YES �NO <br />MECHAIdICAL PERMIT APPLICATION <br />TypoolProject: _New_Addn _Alteralion_Repair <br />Show Num6cr (N) ol lirfuics <br />A/C - air handlinq unns <br />Gas <br />hood <br />d lan <br />� Other <br />SPRINKLER I SUPPRESSION SYSTEM <br />Numher ol Heads <br />PLUMBING PERMIT APPLICATION <br />ol Project: _New _Addn _Allerali0n _RepTir <br />Show Numbcrlql ollixfures <br />Floor <br />Medical Gas <br />Olher. <br />I hereby cerlily thai I have reaA and ezamined Ihis appliwlion and knov� Ihe :ame to he hue and correct All provision; ol law; and ordlnance; govr.mmg <br />Ihu lype ol wnrk vnll he comphetl wilh wNeOier ;pecifed heiein nr nol Thr, yranting al a pr.rmit does nul pre,ume lo �rve �ulhonly Io violale or cancel <br />tne provision ol any olher slale or local law regulalmg conslruclion or the pertormance of constmclioa Thot I am authorized by Ihe ovmer ol th ; property <br />to perlo Ihe worh lo� which applicahon is made and I wmply with ihe Slate Conlraclors Ww 1B 27 RCW and 296 200 WAC <br />/'/o •/ <br />wncr/AWhorizedAgontSi o D.la l�������'dz�'�>>) <br />