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�ERMIT APPUCATI� <br /> BUILDINGIMECHANICAL/PLUMBING/SIGN/SPRINKLERIDEMOL.ITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> � 3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br /> SITEADDRE S: � - PROPERTYTA7f11 PERMITA'� <br /> / � Wrf <br /> LEGAL fof new conslNction: Short PlaVsubtlivislon Lol No._ (atlac�copy o110ng legal descnption) <br /> OWNER (�, , Phone/E•meil <br /> ACdress '� CilylSta�e2ip �/ W� �20 <br /> APPUCANT:_Owner _Owner'sAgeol _Conlraclor _Contraclor'sAgent _Tenanllm�+tpo.aoeionna:cwxmimmmea.,erioa>wonnu+.spacel <br /> CONTRACTOR �I E}��IS vw-bc State Lic.p Q c�ir e�5. u�. a p <br /> Address P�onefEmail ZS '7�fZ �]7 <br /> C TACT F T ���� <br /> PhonelE-mail 2 7 Z <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK �J �O <br /> Existing Use of Building ��S�St _ HEAT SOURCE; � <br /> Proposed Use of B Iding Gas_ Eiectnc_ olher <br /> Building type. �Single Family _Duplex_Townhouse _Multi• amily _Commercial <br /> Type of project: New _Addltion Remodel Repair T.I. _Sign Sprinkler Demolilion_Change of Use <br /> DESCRIPTION OF WORK(adddiona�spacepmvidedon tne back): <br /> �jr'�-� .�� (hi �.�0.W � /(�ySr.o/1'�' <br /> M NICAL ER IT PLI ATION PL BIN PE IT LI TI <br /> Type ot Pro�ect: _New_Addn _Allerotlon_Repair Type ol Projecl: _New_AAdn _Alteration_Repalr <br /> S�aw Number(N)ol/idures Show Number(NJ ol�.rtures <br /> A/C—air hantliin unils Toilet <br /> Forcetl air s slems Bathtub <br /> Gas piping Lavatory(wash basin) <br /> Waler heater Shower <br /> Gas fireplace Kilchen sink 8 disposal <br /> , Gas range Dishwasher <br /> Clothes dryer Glothes washer <br /> Range hood Water heater <br /> Ezhaust lan Sink(service/barlmoplelc.) <br /> Heat pump / Backilow preventcr(inside bldg) <br /> Unit heater Urinal <br /> Botler Drinkin Founlain <br /> Retrigeralion Floor tlrain <br /> Woodstove Grease Irap <br /> Uuctin9 Roof drains <br /> Other Medical Gas <br /> SPRINKLER I SUPPRESSION SYSTEM Other. <br /> Number of Heads Olher. <br /> I MreDy certity I�al I�ave reaC aixl examinrE I�is appLui�an and know Ihe same lo Ee Ime nnd mrtecl.All p�onsions ol Inws and o�E�nnnces govemin9lhis qpe ol�ro�k wel Ee campi:ed <br /> wAh wAelM�i speciln.a perein or nol.T�e graNin9 0l a pelmit Gae,nol presume l0 9rve aut�only lo vrolate ar cnncel l�c p�ovislon ol nny olher slale o1 hcal law regulatmg conslmclbn <br /> Thnt I' aul au d Gy IAe ownci o11Ns propedy lu fcAmm t�e wofk lor w�ic�applrcalbn is mndc nnd I rAmply wdh Ihc Stale ConVactors Lnw 1B 7.T RCW anE 776 POOA WAC. <br /> Owner�e Agenl Signature ����� (Revised 4R015) <br />