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� � <br /> PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBINGISIGN/SPRINKLE:R/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 /> SITEADDRESS: PqOPERTYTAI(p PE / O � <br /> 1�1 (�S�r Q/ <br /> LEGAL lor new conslruction: ShoA PlaUsubdivislon Lol No._ (atlach coDY ol lonq IeOal descriplion) <br /> OWNER L�„ ph PnoneiE-mail <br /> Address Gty/Slate2ip <br /> APPLICAN7: Owner OwnefsAgenl _Conlraclor ConlreclolsAgeN Tenanllmw�po.a..i.veroi�sm..�r�omm�a.n.rmao.minu�+p.r.� <br /> CONTRACTOR /uUC✓� Y��•r �in � SlateLic.KMOC/�(/ *" ,jTU Cil Bus.Lic. p055�o3s <br /> Address �7s�5 yr�5!- Sc SiW un� � l../ ��1 4�Z�tU PhonelEm I �1�'V Mu:n w-��i�w taµ+ <br /> TENANT BUS N SS AM CONTACT FOR PERMIT <br /> PhonelE-mail <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> EKisting Use ot Buildmg h1EAT SOURCE�. <br /> Proposed Use of Owlding_ Gas Elednc Omar <br /> Bwlding type� �Singlc Femily _Dupiex_Townhouse Mulli�Family _Commercial <br /> 7ype ol pw�ect. _New Addnlon � RemoAel Repav T.I. Sign _Spnnkler Demoldion Change ol Use <br /> DESCRIPTION OF WORK(udd�Honel space provided on tno nacM): ,j <br /> �r� ��� �t��. C�wr2. �'i. �c��r �.-r�, d— � � Ull � N <br /> Uk_ I�.Rf ('�7�1�.�d+U� � r ,'LL, <br /> MECHANICAL PERMIT APPLICATION PLUMdING PERMIT APPLICATION <br /> iype of Pro�xet: _Now_Addn _Alforollon__Hopalr Typo o(Projecl: _Now_AdJn _Allerallon_Ropair <br /> S�ow Number(N)o/llrfures Sbow Num6er(M)o//irfures <br /> AIC—air hanJlin unils i Totlet <br /> Forced ah syslems Bathlub <br /> Gas pipm. Lavalo wash basin) <br /> Waler heater Shower <br /> � Gas lireplaa; Kdchen smk 8 d�sposal <br /> Gas range Dishwashcr <br /> �----- <br /> � Clolhes dryer Clolhc.^,washr.r <br /> Range hootl � Watcn c�atcr <br /> Exhaust lan Sink(service/badmop/elc) <br /> Heat um Dackllow prevenler <br /> UnA healer Urinal <br /> Boiler Dnnking Fauntain <br /> Rehi9eralion Floor Arain <br /> Woodstove Grease Ira <br /> Uuchng Roof drams <br /> Other Metlical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM o�her <br /> Numbcr ol Ilcads O�hm. <br /> I�creby cerlM I�wl I�nvc rcad nnd c.amineA Ihn appb�iion nn0 know I�c.nma lo Oo Vuo nnd rarmd All provnion.ul lawa nntl mOmonu:.qovemmg I�is lypc ol woA vnll pc wmpi eC <br /> wnh wnellier sper.�hni1�crcin ar nol Tne p.unl�nq ol n pr�m�Aaes na�piesuma to yrva aWMrny lo vmlatc or wnul Inc provislon al onY o�Ocr st�la or lowl law tcpW�tmg wnstruclion <br /> Inei I nm aatnurveG by Viu uwnn ul iMs D�oDeny la prtlo�m i�o vrorA fa wMc�apD��t�on Is matle nn01 comDly wA�I�e Stale Contrac�ors l aw 10 77 RCW ena 796100A WAC <br /> --�-�'���— �-z� - �s' <br /> OwnedAuthoNzeJ Agenl Signature Dalr. (RewsedYlOIJJ <br />