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� <br /> PERMIT APPLICATION <br /> BUILDINGIMECHANICALIPLUMBINGISIGNISPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett,WA 98201 -425-257-8810— FAX 425-257-8857—www.everet a. rg <br /> pPPLICATIONB ARE ACCEPTED FROM 8 AM TO 1 PM /D <br /> SITE ADDRESB:I PROVER7Y iAlf M P RM T <br /> ,,o2r w �sno Q� o � ia.ho3o o a -v <br /> LE6AL lor new conelrucllon: Sho�PleVaubtlivlelon Lol No._ (attech copy of lo�p lepel detcriptlon) <br /> OWNER � //k�!��� !�C �I � �ST � PhonelE-meil <br /> Addre6f Clly/Stele/Zip <br /> CONTRACTOR Q �v ✓' L 8 I Lic.tl <br /> Addmse PhonefEmall <br /> TENANT BUSINESS NAME CONTACT fOR PERMIT q�=,b 0.�S <br /> � L�2S- 3S$-�P`(�`� <br /> �G�/�J �'j(Wb PhonelE-mail M ��• � <br /> BUILDING PEItMIT APPLICATION CONTRACT FRICE OF WORK <br /> Existing Usa ol8uilding HEAT SOURCE: <br /> Proposed Use ol Building Gee Electr�c Other <br /> Building type: _Single Femily _Duplex_Townhouse _Mulli-Femily _Commerciel <br /> Type ot pro�ect: _New _Addition _Remodel _Repalr_T.I._Sign_Sprinkler_Demolition_Chenge of Use <br /> DesCrip�ion Oi WOrk(ed`dilionel space provided on fhe beck�: . � <br /> � .�• �Pr U4�CS� � C��rtr�s �U� — SMGrcqJG� St2C �34a � <br /> Have you ataAed working wilhout a permil7 _VES _NO <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Pro�ecl: _Naw_Addn _Altarallon_Repslr Typa ol ProJecl: _Naw_Addn _Alter�llon_Rsp�ir <br /> Show Number(M)ol llxturea Show Numbor ol/lxfuns <br /> A/C—air handlin units Toilet <br /> Forced air s stems Bethlub <br /> Gas i m lavelo weah basin <br /> Water healer Sho��Her <br /> Gas fre lace Kitchen aink 8 dis osel <br /> Gas ran e Diahwasher <br /> Clothes d er Clolhes washer <br /> Ran e hood Weter healer <br /> Exhausl fan Sink(servicelbar/mo lelc. <br /> Heal pum Back�ow reventer <br /> Unit heater Urinel <br /> Builer Dnnkin Founlain <br /> Relri eration Floor drein <br /> Woodslove Grease�ra <br /> Duc�in Rool draine <br /> Other Medical Ges <br /> SPRINKLER I SUPPRESSION 8YSTEM otnar: <br /> Number of Heads Ulher: <br /> I hereby certiy Ihel I have read end exemined Ihle epDllcellon end know ihe eeme lo be Irua and cortoct.All provisians ol lewt end ortlinencee poveminq <br /> Ihis type ol work will be complied wilh whelher specifed herein or not.The grenling ol e permll does nol preeume lo piva authotl�y lo vlolete o�cencel <br /> Ihe � ol eny o er etele or locel law regulalinp consWclion or Ihe pedormence of conslruction.1 het 1 em eulhodzed Ey Ihe owner ol lhle property <br /> lo eNa�m Ihe ork 1 which epplicallon ie made end I comply wilh I�e Slele Conlreclon Lew 1B 27 RCW and 290200 WAC <br /> nwnerlA orizedAgen Ign�Wre O e (ReviseC?/t011/ I� <br /> � " <br />