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�ERIViIT APPLI��ATION <br /> BUILDING/MECHANICAL/PLl1MBING/SIGNISPRINKLER/DEM�LITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., F.verEtt, WA 98201 425-257-8810 FAX 425-257-8857 www.evere;nva.org <br /> APPLICATIONS ARE ACCEPTED F70M 8 AM TO 4 PM � -a �- �3 <br /> SITF� ,Pf2R�. ��^jjt /• � /+�., PROPERTVTAKq PE MT <br /> O�•��0� S7- L�LI/ � ' �� <br /> LEGAL fcr new conslmct;on: Short FlaVsu6division__ Lot No._ (altach copy ol long legal descrip�ion) <br /> OWNER ( ��S/F-��G! �JG�S^�f/� Phonc/E-mail <br /> Atldress .Q, � ��r�� Ciry/SlatelZip G(JZIr-£( � <br /> APPLICANT:_Owner OwneisAyenl _ConUactor CONmetefsArant _Tenanl���niv�����oa�eoerom:���e�incmmeo..r.�rioao�oa�nwosaa=1 <br /> CONTRACTOR ����d• ���'FG�b ~ L�:I Lic.�: D Wt/Jg4 C IO� ��[T COE Bus.Lic.# <br /> Address ��a� �owLf.E— /pY2 �'J, �t,• Zd �none�emaa ZS- 3`f3` tl(Z�— <br /> TENANT BUS;NESS NAME � CONTACT FOR PERMIT <br /> � V - t — <br /> _) � � U,Ty�L�.L� /L t �6!/}NfL C,QI'f'wt'!J2 U <br /> �"��5 �j /� $ / . �!C�L �(S� Prane/E-mail 2 S � ^� 3- �l ZZ <br /> BUILDINGPERMlTAPPLICATION coNTRAC7PRICEOFwoRK_ � _ <br /> Existing Use of Bui'ding_ HEAT SOURCE: <br /> Proposed Use of Brilding Gas_ Eiediic__ Oiher_ <br /> Building type: Sing!e Family _Duptez_Townhouse _Multl-Fanily _Commercial <br /> Type of project New _Addition _Remodel _Repair_T.I._Sign_Sprinkler__Demolition_Change of Use <br /> DESCRIPTION OF WORK(addifional space provid=d on(he baeh): � +� � <br /> � ,_ . - . - — ,- `- , <br /> /� � • •./ .'�wwMIG <br /> L <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATRBN <br /> TypeofProfeuC _New_Addn _Altcratlon_Repalr Typeo(Project _New_Addn _�Ileration_Repalr <br /> Shmv Num6cr(N)o(lialures �Shaw Num6c�(6)a!liaYums <br /> AIC-airhandlingunils _ Toilet <br /> Forced air systems • � Ba�h�ub <br /> Gas piping Lavalory(wash basiN <br /> Water heater ' Sho�ve; <br /> Gas fireplace _ Ki�chen sink&disposal <br /> Gas range �ishwasher <br /> Clothes dryer Clothes�vasher <br /> Range hood Water heater <br /> , Exhaust fan I Sink(service/bar/mopletc.) <br /> Heal pump Backflow preventer <br /> Unit heater Urinal <br /> Boiier Drinking FauNain <br /> Refrigeralion Floor drain <br /> Woodslove Grease Irap <br /> Duc�ing Roof Crains <br /> Otfier Medical Gas <br /> SPkINKLER/ SUPPRESSION SYSTEM O�her: <br /> NumSer of Heads Other. �I <br /> I here�y cM�ty Ih�1 I have mad and uxamNed Ihis opD�iculion and Anow'�o s:.m i�o Ee Uua aad corted.A!I^roeisions ol lows antl orEinances 9uveming ihia typa al work vnll ba complied <br /> r.�.hrAiclherspedEcahe�� ornol.ThogmnS���Ba��Pertnildoeanolptc5umolo0naauthonryloWo�alourcancellhepmvisionolanyolhe�statoortocollawmgulnlingccnslmdion <br /> �he �mhotlzed Iho mv et ol NIf pmpeM�a edann Uo work lonvhich nppucallon b made and I rompy wth Ihe Slalo Canlracmre Law 182i RCVland 258200A WAC. <br /> (Z �LI ^�L'_ <br /> Ow erlAul d:etl Agent Signature �afe (Revised WZOI2J <br />