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� � , <br /> PERMIT APPLICATION <br /> BUILDINGIMECHANICALIPLUMBINGISIGN/SPRINKLERIDEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., [verett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br /> SITEADDRESSQ'. � PROPERTVTA%q PE ITp M <br /> � Z—W <br /> LEGAI for new construclion� S�oA PlnVsubdivision Lot No._ (allach copy ol long legal descnpt�on) <br /> OWNER ��� Phone�E-mad p�'�� V ✓Y� �• <br /> Adtlress Cily/Slatc/Z�p <br /> APPLICANT: O.vner Owne,Agent Veonlraclor Contractor'sAgent Tenanl�m.,ic�o.me�mc�rorw�.�m�rom•.rwo�..M�ua�..o.r���mo:w.�� <br /> CONTRACTOR V M LJ f ✓� � State Lic. a . /% V I � Ciry Ous. Lic. # �S �S�O <br /> Adtlress C/ � S {rG1.(�u� (.. PhonClEma�l �-�—'y B� "d� � <br /> TENANT USINESS NAME C�ONhTACT FOR PpERMIT <br /> �1�–� � �U��—T0�2 3 r� J) <br /> Phone�E-maA VC �— IL n�r br� ��C 4 <br /> BUILDINGPERMITAPPLICATION CONTRACTPRICEOFWORK IOD� '-- C7 �'l/ <br /> Exisling Use of Butldm� HEAT SOURCE: <br /> Proposed Use of 8wlding Gas_ Eiectnc_ Other_ <br /> Bulidmg typc _Single Fam�ly _Duplex_Townhousc: __Multi-Fam�ly _Commercial <br /> Type ol prolecC New AddRion _Remodel __Repair_TJ _Sign_Spnnkler_Demolition_Change of Use <br /> DE$CRIPTION OF WORK(atld���onal space p�ovide�os Ihe back): <br /> MECHANICAL PERMIT APPLICATfON PLllMBING PERMIT APPLICATIGN <br /> Typc ol ProjttC _Ncvi_Addn _Alteralion_Ropair Typo af Projetk _New_Addn _Alteratlon_Ropair <br /> Show NunMer(M)01 lixtures Show Numbcr(N)o/!ix(ures <br /> A/C—air handling umts Todel <br /> Forced air sys�ems I Oathlub <br /> Gas nip�ng I Lavatory(wash basin) <br /> Watcn c�aler � Shorrer <br /> � Gas fireplace Kilchen smk&disposal <br /> Gas ranga Dishwasher <br /> � Clolhes dryer Clolhes washer <br /> Range hood Water heater <br /> Exhaust lan Sink(servicelbarlmopletc.) <br /> Heal pump �ack0ow preventer <br /> Und heater I Urmal <br /> �oiler � Drinkmg Pounlain <br /> Refrigeration Floor drain <br /> Woodslove Grease trap <br /> Ducbnq Roof drains <br /> Other Medical Gas <br /> SPRINKLER I SUPPRESSION SYSTEM Olhec <br /> Number of Heads I Olher: <br /> I Rere�y ce�dy I�at 1�ave read anE e�aminetl I�iS applcalion antl knc.v I�e Same lo be INe anE srtect !dl piovisions ol laws o�d o���nances r,weming I�is lype ol work w�9 Ce compi�.e�f <br /> wn�Nfiel�er 5 ecA�ea�erem or not Tne g�aNmg ol a penne Eoes not 0�esume togire aul�Or�ly ro v�olale or can:cl um 0'ovision of a�y dner elale or Iccal law�eguialm�r.nsiroc�nn <br /> Thall' aulhcri:etl yt�eo.merollT,pmRe�yloFCAOmll�ex'orAlol�M¢bapp!iWlionismaCeanalcomclywd�l0e51d1eConvacloRLa�.v1B27FC'Nantl:562��411'rC <br /> i�-a� <br /> OwnedAWhorized Agenl Slgnature Date (Fev�sed 3.077) <br />