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� ( <br /> PERMIT APPLICATION <br /> BUILDINGIMECHANICAUPLUMBINGISIGNISPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett,WA 98201 -425-257-8810-FAX 425-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM!AM TO 4 PM <br /> SI�TE�A�DRESS: MOPEIITYTAI(R MIT� _ OZ�CJ <br /> ,,� Z 0 00 <br /> LEGAL lor new constnxtbn: Short PIaU�uOGivisbn LW No._ pttedi mVY ol b�7 b9al OeecriMbn) <br /> OWHER S�'� �T Pnone�E�li � � �7G <br /> ACrcst PD cpUx / Ciry/SlatdZip �� rn W n -1 5 <br /> CONTRACTOR N�����* �7 L B I Lie.ll GOG �S <br /> OOreu PhonNEmall � a, v L��� <br /> NANT U 1 r 11� ,� /'`� ONTA T F a y� <br /> ��pJl� `,,0W1�V,Ah�,�{ W�� PhonelE-mail ZOG .�1'1'� <br /> V <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Exisling Use of Building n�,,��7.,S. '(�hfl� HEAT SOURCE: <br /> Propoaed Use of Buildinp l..Vc7��'(�Olh_�' Gs� Eiennc Other <br /> Buildingtype: _SingbFemily _Duplez_Townhouse _Multi•Family �Commercial <br /> Type o(projecl: _New _Addilion _Remodel _Repeir�T.I._Sipn_Sprinkbr_Demolition_Chenpe ot Use <br /> DEscriplion 01 WOtk(eOdifional spce provitled on the beck): r1��,�P(� S�P Q� �V�,��`-1Q�('�J\ahj , <br /> Ov�r�,,� tD Ael��trn�Y�e.bu�,��db�c.k-. YcynS �K �JCM'S s'-1�� oj•�.�'Scc�e. <br /> �5 CNMQ�• 'B�n\\d��Ll(. Y� 1�- ��\�e,� p�,15 � <br /> Haw you�taMd workinp without a p�rmlt7 _YES �LNO <br /> MECIIANICAL PERMIT APPLICATION PLUMSINO PERMIT APP�ICATION <br /> Typ�otProjen: _N�w_Addn _Albratlon_Rpalr TYWaProJect: _N�w_AAdn _AlhrMlon_RpNr <br /> Show NumMr o/llaluni Slrow Numb�r of Nxnns <br /> AIC—eirhendlin unRa Toilet <br /> Forced aIr s stema BpMWb <br /> Gas i in Lavato wath batin <br /> Weler heafer Shower <br /> Ges fim lace Kitchen aink&dis oaal <br /> i Gas ran e Dithwasher <br /> Clothen d er Clothes waaher <br /> Ran e hood Waler heater <br /> Ezhaust(an Sfnk �ervitslWdmo etc. <br /> Heat um Badcllow �eveMer <br /> Unit heater Urinal <br /> Boiler Drinkin Fountein <br /> Refri eretion Floor drain <br /> Woodstove Groase tra <br /> � Dudin Roof Crains <br /> I Oth:r Mediul Gas <br /> SPRINKLER I SUPPRESSION EYST[M aher: <br /> � Number ot Heads an°r: <br /> 1 hereby certiy tnat 1 have rea0 end ezeminetl this appliution and know Ihe same to Oe tnre anE comaU.All provialone of laws en0 adin�ncas poveminp <br /> l�ia rype ol wurk vnll De complieC wit�whel�er specifietl herein or not The pro�airp o1�permit Ocea mt pfasume lo pive�uthorily to viol�ta or ancel <br /> the provision o�any other state or local law repulatinq wnstrudion or t�e perlwmence ol eonetn�dion.1Mt I am e�thorlisC W�lie wme�a U�a qoperty <br /> to pedorm ha wark for wtiioh epplication Is maCe anC I compy wit�t�e Stele Contncton I.�w 1827 P.CW�rW 298.200 WAC <br /> � \ <br /> OwnarlAuthodz Apen�8 p iWn a e (Revised7/20H) <br /> ' <br /> ! ✓` <br />