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� � <br /> PERMI�' APPLICATION <br /> BUILDING/MECHANICAL/PLUMBINGlSIGN/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 /> SITE ADDRESS: PROPERiY TAl(p PERMIT Y <br /> ��' s �-^2 05-oo�O <br /> LEGAL tor new canstruclion: Short PlaVsubdivlsion Lot No._ (etlach copy ol long legal tlr:scrlpflon) <br /> OWNER Ili L� �,..�c,��Q��ic.�,/ P�onelE-mail /ZS� a S�� � 3 7� <br /> Adtlfe55 t ��'� IT�C.I�.2 City/SIa�e2ip � � '��'j. � <br /> APPLICANT: Owner OwnefsAgenl Conlraclor ComractoYsAgent Tenant(mesipmYaeolenwalmmemrtomme�.nrrmmwonlnmovpaea� <br /> CONTRACTOR /�UL,� y �c..r�-� 1�in � State�ic.uMocnP/ � j,T(� Di� e�s.uc. x053�35 <br /> Address �7s� 5 y(�5{- SC S�yq Uh'S� WI�1 (S�Z�fU PhonelEma ��6j �.� Mu:nPl�r,�i�� cav++ <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> P�onelE-mall . <br /> BUILDING PERMIT APPLICATION CUNTRACT PRICE OF WORK <br /> Existing Use ot Buiiding HEAT SOURCE: <br /> Proposed Use of Building � Gas Eiearic other <br /> Buildingtype: _SingleFamiiy _Duplez_Townhouse _Mulli-Family _Commercial <br /> Type of project: _New _Addition Remodel Repair__T.I. Sign_5 rinkler Demolition Change of Use <br /> DESCRIPTION OF WORK(addltiona�space providod on Ine nack/: <br /> s� , �,i� �-r� ;x �� �� v�,�,,<. ��. h�,��..� <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> TypeolProJect: _Naw_AEtln _Altnratlon_Ropolr TypoofProjact: _Naw_Addn _Alleretlon_Ropair <br /> SAow Number(It)of fixtures Show Number(q)o/fixtmes <br /> AIC—air handling units Toilet <br /> I Forced air systems Bathtub <br /> Gas piping Lavato wash basin <br /> Water heater Shower <br /> � Gas fireplace Kitchen sink&disposai <br /> Gas ran e Dishwasher <br /> � Clolhes d or Clothes washer <br /> Ran e hootl Water heater <br /> I Exhaus� fan Sink(service/barlmop/etc.) <br /> Heat ump � � Backflow prevenler <br /> Unit heater Urinal <br /> Boiler Drinking Fountein <br /> Re6igeration Floor drain <br /> Woodstove Grease tro <br /> Ducling Roof drains <br /> Other MEdical Gas <br /> SPRINKLER / SUPPRESSIQN SVSTEM o�her: <br /> Numbcr of Head:�. I� Olher. <br /> I Aem6y ceMy Ihat I�nve reed entl enmhed Nis opplirnGon and Mow No soma�o Ea Imo uM mrtecl.All pmvisiane of Iwn onE orOlnoncea Ooveming Nb lype ef woik vnll Ee tompfetl <br /> wnh wneNer epeM�eU nenin or not.TTe gmnting ol a pe'mX Goes nol prceume b glue euNonry to vlolate of Cancel IIIe D���tlon of ony otAet state of locall8lv feBulating conSWetlm <br /> 7Ta1 I am aathoracd by Ihu owncr ot Nls pmperty Io pertarm me work far wntrn eDDn�lon Is maae enG 1 mmpy�Wli No Slato ConVaclors lew 18.27 RCW enE 296.tODA 1M1'AC. <br /> ���"�- S -��'� f <br /> OwnerlAuthorized Aganl Signeturc Dale (Revised 3R07J) <br />