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� � <br /> PERMIT APPLICATION <br /> BUILDINGIMECHANICAL/PLUMBING/SIGNISPRINKLER/DEMOLITIUN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everethva.org <br /> y —�o�i3 <br /> SITEADDRESS: PROPERNTAXI! PE MIT# <br /> y�D 8 bv�2Ln�e,✓ CuA � D p 30`� — [�02. <br /> LEGAL for new constmctlon: Short PlaUsuhdivision Lo(No.__ (attach copy ol long legal descriplion) <br /> OWNER �( �j ���j _ � Phone�E�mail �Zrj - CL�7 0 � / '�v <br /> Address �� $ ve( ��-C V� � CitylStatelZip �[�JQ.���'7 Wf'� 0 ��� <br /> APPUCANT:�Owner _Owner'sAgent _Conlraclor _ConlracloYSAgeN Tenanifm�sioro�moamneroiconsamimnmoownerioao.en�ninasPaca� <br /> CONTRACTOR �� State Lic. # �i N LL gSb D J City Bus. Lic. # <br /> Atltlress , �� r�.°!�(l114V � �,v W�L ( 0 Z7 Phonc/Email <br /> TENANT BUSINESS NAME �/C`(,�N��i G � �'�art CONTACT FOR PERMIT <br /> �l J�,m Roasrr'�. <br /> PhonclE-mail y�,5-25$- q i �c� <br /> BUlLDING PERMIT APPLICATION coNTRAc7 PRicE oF woRK �SO'= <br /> Existing Use of Building_ � �'�r7�L HEAT SOURCE: <br /> Pwposed Use o(BuilAing� E � �� L/fLA(_�i!� _ Gas_ Eleclric_ Olher__ <br /> 9uilding type: _Single Family _Duplex_Townhouse _Multi-Family _Commercial <br /> T�pe of pro�ect: New _Addition Remodel _Repair_T.L_Sign Sprinkler_Demolition_Change of Use <br /> DESCRIPTIONOFWORK(adddionalspacoprovidedonrheback) ��`,,1\. � �•`n11� �����• n� �N <br /> "F�l\ <br /> ���► �n� S��n oF a�{�i�i� c:F �'ve�e�1 C ���F�e� +�e- O���eC� <br /> MECH/!.N(CAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> TypuofProjocC _Now_Addn _Alteralion_Repair TypeofProjecl: _New_Addn _Alloration_Repair <br /> Show Num6cr(d)o(liafums Show Numbcr(M)o/lixfures <br /> NC —air handling units Toile� <br /> forced air syslems Bathtub <br /> Gas pipin9 Lavatory (wash basin) <br /> Waler heater Shower <br /> Gas f�mplace Kilchen sink&disposal <br /> Gas rangc Dishwasher <br /> Clothes dryer Clothes v�asher <br /> Range hood Water healer <br /> Exhaust lan Sink(scrvicMbadmop/elc.) <br /> Heal pump � Oackllow preven�er <br /> Unil heater Urinal <br /> Boiler Drinking Founlain • <br /> Relrigcralion Floor drain <br /> Woodslove Grease trap <br /> Ducling Roof drains <br /> Olher Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM Other: <br /> Number of Heads � Olher: <br /> I hcrcby ee�ily IOa�I�avu read and exom�ned Inu appLcalion and know Ine,amc to bc Imc and wimtl.All pmvision•,ol laws ond mtlmances goveming Ihis lypc ol work wAI�c comp:,o0 <br /> vnln whelher specAietl�elein ar nol Tpe qranlin9 ol a permit tlocs nol piesume lo givo aul�only Io violnle or Wncel lhe piovision ol anV olner:ialo ar lowl larv ieqWalrn9 mmlmclinn <br /> T aul�onzc0 OY�nc o'nrar al Ihi;proDcny to petlorm tlw woik br Ktnch appbw6on is mmfu nnd l compy wi10 t�o Sln�o COMmctor9 Lavi f B 77 FCN/anJ 796 200A V.�AC. <br /> I/� <br /> L ` ` ` <br /> Owl�br/Aulhonted Agenl Slgnaluro alc (f�����sed3?U73) <br /> � <br />