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/ <br /> "�Yl' I,G���I� �i 1/\. `��' ' <br /> / � <br /> PERMIT APPLICATION � F�' <br /> BUILDINGIMECHANICAL/PLUMBING/SlGN/SPRINKLERIDEMOLITION ; <br /> CITY OF EVERETT PERMIT SERVICES (-11 �-13 <br /> 3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.urg <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITEADDRESS; PROPEN7YTA%q PERMITp _ <br /> � Z s-- r�' S' {� / �7 - OU S <br /> LEGAL lor new constmclion: Short PlaVsubdivision Lot No._ (altach copy of long legal descriplion) <br /> OWNER l�1 �{-��V��YI�--l � Phone/E-mail <br /> Atldress � ,S CitylSlalelZip �Z�� <br /> APPLICANT: Owner OwnefsAgent yContractor Conlractor'sAgent TenaNem�,s�p�ova.ekrsrmcc�semnommeo.mermaowon�nmo�ca:o� <br /> CONTRACTOR D� �.� I��� L&I Lic.# D D P U I � k COE Bus.Lic.# <br /> Addmss P�onelEmail <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT yZ S z�`I ��f�'� <br /> n'� y c-ll /V1an � c,fu� n PhonelE-mail �,.r t 'Zoe �•, p� <br /> BUILDING PERMIT APPLICATIO CON7RACTPRICEOF WORK <br /> Exisling Use of Building HEAT SOURCE: <br /> Proposed Use of Building Gas_ Elednc_ otner_ <br /> Building type: _Sirgle Family _Duplex_Townhouse _Multi-Family _Commercial <br /> Type of projecl: _New _Addition _Remodel _Repair_T.I._Sign_Sprinkler_Cemolition_Change of Use <br /> DESCRIPTION OF WORK(additional sFace p�o�idetl on(he back): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Typeo(ProjecL• _New_Addn _Alteratlon_Repair �TypeofPro�ect: _New_Atltln _Alteration_Repalr <br /> Show Number(tl)of/ixtures Show Num6er(#)ol!ix(ures <br /> A/C—air handling units Toilet <br /> Forced air systems I Bathtub <br /> Gas piping Lavatory pvash basin) <br /> Water heater I Shower <br /> � Gas fireplace Kitchen sink&disposal <br /> � Gas range Dishwasher <br /> Ctothes dryer I C!othes washer <br /> Range hood Water heater <br /> Exhaust fan I Sink(service/bar/mop/e�c.) <br /> Heal pump BackOow preventer <br /> Unit heater I Urinal <br /> Boiler � Drinking Fountain <br /> Refrigeration I Floor drain <br /> Woodstove Grease trep <br /> Ducling Roof drains <br /> Other � Medical Gas <br /> SPRINKLER I SUPPRESSION SYSTEM other. � c,.:: :, l< <br /> Number of Heads Other: <br /> I hereby cerlAy Ihat I�avo reaC and esamined Ihia apPlicnlion ond knmv iha somo lo Co Ime anC cortect.All provisions oi laws anG orCinanwa goveminB Nis rypa vlwork n+ll o-_complie� I <br /> rni��MCIfiM sp..cifetl herein or nol.i�o Branting ol a pertnit Eues noi prcsumo lo qve amnorry lo Wolale or concel Na pmviswn o/eny oNer stale or local bw reBulaling con,W r,ion <br /> T�at I am out�onzetl by Ihe mvner oll�is property lo petlorm Itio work forwhic�appfcnlion If maCa and I[ompN wih lhe Stato ConVatlors Law 1827 RCW an0 29820�A b'.'AC. I <br /> � <br /> '""� /�r ,�'t��'� �,—�_.-1� i� - .2 �Cate� (Revised G/2o12) <br /> OwnerlAuthodzed Agent SlgnaWrc <br />