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� � <br /> PERMIT APPLICATION <br /> BUILDING/MECHANICALIPLUMBINGISIGNISPRINKLER/DEMOLIT�ON <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettv+a.org <br /> SITE ADDRESS: �ROPERTI�TA%u P Ii x _� <br /> i� la ���,,.c� „� 0 <br /> LEGAL fo�new constwclion Shoh PIaUSuborvi5mn lot No (aliach copy of long iegal descnp0on� <br /> OWNER c.�� USL�6,(� Phoner6matl <br /> Adtlress ���� U �f�.,n �JC C��ylSWICR�P �iV°„'�T � �l�/1" �1� �`1 <br /> APPLICANT: 0�•�ner Owner'sAgent Cont�aeio� �Canlractor's�gent �enaNim�ucn..e�aie��.�oic:rsen•�.�ran.ro��oc:..v+ ono+o�wl <br /> CONTRACTOR 5�.,.cr �����n��� • � Slale L�c # �w<<� � `����5 Gry Bus L�c # 6'l'1 y� <br /> ndaress � ��5 6 zc�ll:ti.� ' vc.. 11. �o(� ' 215G ` 7V j� <br /> � Pnone/Emad <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> / y SL.J�� ��4.�� . �tM <br /> , rob �j <br /> �o�..�r r ;;c.,0/ �na��,e.m��i �v�J 'l�s-��7`L-3133 <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> E.�sung Use o(F3udd�ng HEAT SOURCG <br /> P•oeosed Use of Bmltling Gas__ Eieclnc__ Cmer_._ <br /> Budd�ng type�. _Smgle Fam�ly _Duplez_Tovmhou5e _Multi-Famtly _Commercial <br /> Type of pro�ecl. New Addihon Remotlel Repair_ T I. _ __S�gn__Spnnkler__Demo��aon_Change of Use <br /> DESCRIPTIONOFWORK /aao,to�:a�su�caF�c.�deaa: e^ac;:� <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type ol Project: _New_Addn _Alteralion_Repart Type of Projecl: _New_AdAn _Alleration Repair <br /> Show Number(MJ ol l�rfures Show Numbcr(u)aI/irfures <br /> I A/C—au handling units Toilet <br /> � Forced a�r systems � 8������� <br /> j Gas pip�ng Lavatory (wash basin) <br /> Wa�er liealer � Shov:er <br /> � Gas fireplate Kdchen sink 8 disposal <br /> � Gas �ange � D�shwasher <br /> � Clo�hr.s tlryer � Clothes washer <br /> Rangz hootl � Water heater <br /> � [nhausl lan Smk(servmelbarimop�etc) <br /> Hcal pump � �ackflow preventer <br /> Unrt healer � Unnal <br /> Boder I Drmkin9 Founlam <br /> � Refrigeration Roor dra�n <br /> Woodstove I Grease Irep <br /> I DuUmq � Roof drams <br /> � O�her Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM Other <br /> � Number of Heads � Other <br /> 1 hereoy cenAy i�ai i Oave iea7 anC e.amin^C tMs aDPhwuon anE knor tAe same lo Ce tme aM mntt� All proviiqr,s ol la�v5 anC oitlinances 90iemmg t0is lype ol�wrh vn I EC[omp�etl <br /> wrn wnemer speo��eO�ero�n or nm Tne gram�ng ol a De���a:es noi presume togne awnorny lo vroiate or canrei V+e pronson o�any omer staie or:ocai iaw iegviot�ng comimc'�on <br /> Thal I am au�onzea Ey i�e anner ol mis pmperty lo peAarm tne work Icr w�2�apD�icaiion�s maEe a��I com;ly wnh t�e Slate Conlracbrs law 1B 17 RCVlanO 25G 200A WAC <br /> �t� � �/7/�J <br /> OwnedAuthorizctl Agenl Signature � Da�e (Rev�sed 3i?073) <br />