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s'E")10'91.7P <br />PERMIT APPLICATION <br />BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/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 B AM TO 4 PM <br />SITE 9plDRl ESseS'�IrIGD/V7 <br />PRQ OR OTXTAX O D% DO �D <br />PE1✓1 <br />LEGAL for new/co,y%strucuon� Short !ti l�lZ(N> t No _ (attach copy of long legal desorption) <br />/P Pllattsubdiv,wonn <br />OWNFii�I�(� <br />odress S/t/D /Pu-P TOW City/Stale/Zip <br />APPLICANT: —Owner _Owners Agent _Contractor ✓}C�omractors Agent Tenant xenah l�m.awe4nxam. vn fcn ew a.r oc <.. �tw roar< <br />CONTRACTORryI / h u�r.. if CO'ELBus Liicc d <br />YIO�f <br />�G <br />�J .J/Q <br />daresa <br />TE NAHT B INE S ME <br />Nl <br />CONTACT FOR P"E� MtT <br />PnnPE na, ffIliLzry>I% <br />BUILDING PERMIT APPLICATION <br />CONTRACT PRICE OF WORK ���• �J <br />//� h / HEAT- /✓ <br />Existing Use of Building L !! y �7/%SOURCE <br />Proposed Use of Building �7 Gas_ _ Electric__ Other_ <br />Building type. _ Single Family _ Duplex Townhouse _ MultFFamily _ Commerual <br />Type of project New Addition Remodel Repair T.I. _ Sian— Sprinkler Demolition_ Change of Use <br />DESCRIPTION FWORK fadddionalspace provided on the back): <br />Tly1 6 l P� pYD ®5& �"o reP lQ,& P' /�Sfl!'/9 <br />MECHANICAL PERMIT APPLICATION <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _Naw_Ad3n _Alteration _Repair <br />Shaw Number S of fixtures <br />Type of Project: _Now_Addn _Altaratlan_Repair <br />Shaw Number (#) of Orfums <br />A/C —air handling units <br />AlI <br />Toilet <br />Forced airs stems <br />Bathtub <br />Gas piping <br />Lavatory (wash basin) <br />Water heater <br />Shower <br />Gas fireplace <br />Kitchen sink 8 disposal <br />Gas range <br />Dishwasher <br />Clothes dryer <br />Clothes washer <br />Range hood <br />Wat.rhealer 1 <br />Exhaust fan <br />Sim Iservicefbadmo fetc <br />Heat pump <br />Bacliflow preventer <br />Unit heater <br />Urinal <br />Boiler <br />Drinking Fountain <br />Refrigeration <br />Floor dram <br />Woodstove <br />Grease trap <br />Ducting <br />Roof drains <br />Other <br />Medical Gas <br />SPRINKLER / SUPPRESSION SYSTEM <br />Other <br />Number of Heads <br />Other. <br />I hereby mlldy met I have reed wk eemnhee the appix em lone xnow the fame w be true and wnect. AD provuimf d tarn me oMerloof governing the type of w A W be wmpw <br />with Whether fpeoW hatpin w no The prvmrq or a Perna eeea no prmrni, b prve eueweh' Ip v'o"w ranee! the en,0&nn of my one, a e a local tew nputalnp (Aniumcb n <br />Thai I am 8ui the awfw( of thin PMP" to perform fro w0M1 fm Whirh ffPl) m u made ark I mmpN yen Ow Sgte Cowen Lew 11117 RCW and 296.200A WAC <br />hAuthbrIted Agent Signature Date (Revised&2012) <br />l tZ <br />