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� � <br /> PERMIT APPLICATION <br /> BUILDING/MECHANICALIPLUMBING/SIGh1/SPRINKLER/DEMOLITIGN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 425-257-SE10 FA;. 425-257-8857 www.everettwa.org <br /> SirE nooRess: rr,oreRnrnxa PE3Mijp � I I _OO <br /> ! I S COM1lzr� /{,ic_ V � ''� <br /> LEGAL lor new eons�mction. Short PlaVsubdivision Lo�No. (altach copy o��ong legal descrip�ion) <br /> OWNER (Sr4e� MGC. 1.r4��CJ� PhonelE�mail � p` S � S 5 7�/ �{ <br /> Address� � � 5 LDn� t,-/C �i/G Ciry/Si.itc/Z�p l;J�CI�� �✓� <br /> APPLICANT:_O�vner _Owner'sAgent �Conlractor _Ccniiactor'sA9en� _Ten.nt�m�iic�c.�a�.�irm,roic�n:e��,vonmoa.�ne�e,eo.:orc;n�,ne•r.,��) <br /> CONTRACTOR MOen P�M i,� Slate Lic # Cily Bus. Lic. #ps „}� <br /> nd�ress � 7�71$ `'�f S% S'f S� $/I.�Ro�. � '�/ `J 0 Pi�one�Emad �-I a S - ]�0 - � J(o C� <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Phonel6mal <br /> BUILDING PERMIT APPLICATION CONTRAC'T PRICE OF WORK <br /> Exis�ing Use of Budding HEAT SOURCE: <br /> Proposed USe o(Building Gas_ Eleclric_ Olher___ <br /> Building type�. _Single Family _Duplex__Townhouse _Multi-Family _Commeraal <br /> Type of projecl' New __Addition _Remodel _Repair ._ .TJ. _Sign_Sprinkler_Demo�i�ion__Change ot Use <br /> DESCRIPTION OF WORK�adddional space prov�ded on Ihe back) <br /> MECHANICAL PERMI7 APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of ProjecC _New_Addn _Nteratiar_Reniir Type of Projech _uew_Addn ,__Altenlion_Repair <br /> Show Number(kJ o!Iixmres Show Numbcr(N)ollixlures <br /> �— AIC–air handling units Toilet <br /> Forced air systems � Bathlub <br /> Gas piping I Lavatory (wash basin) <br /> Water heater � Shower <br /> � Gas freplace � Kitchen sink B disposal <br /> Gas ran9e Dishwasher <br /> � Clolhes dryer � qothes washer <br /> � Range hood Waier heafer <br /> � Cxhaus�fan Sink (service/badmop/e�c) <br /> �� hleal pump � [3ackflow prcveNer <br /> Unit heafer Urinal <br /> E3oilcr � Drinking Fountam <br /> ReGigeration Floor drain <br /> Woodsiove Grease Irap <br /> Duchng � Roo(drains <br /> Other Medical Gas <br /> SPRINKLER I SUPPRESSlON SYSTEM o�hcr <br /> INumbero(Fleads � Olher. <br /> i;�eueLy ceihly I�al I have rcatl;m�l e.ommcef I��,s apphca'�on aml I,nvrv the;ame lo be Irue and conect MI pmvisions ol law,and oiunancm gnvermn91ha lype ol v�ork wCl be ccrnpbctl <br /> ..i�l�wM1Cl�ef speciLe�tierein or nol TpC ryia,�Lng ot e permd r1oe5 not pre,ume to 9rve aul�orAy lo violale or Gmcel��e provisron ol any oc^�:�alr oi bcal law regulalmq con�druclmn <br /> I nat I Um aW�ofrzca Cy I�o owner o11M5 propetly lo petlarm tite woik lor oiNch apphcdhnn u mo�e on�I i ompl/�.wln Ipe ilalc f,onVarJcu Lavi 10 27 RCV/antl 79F 700A Y.�4q <br /> -�� ��-�--- --��,1.��� <br /> OwnedAulhorimd Agent Sirynnlure Oaln (Revisotl3/7017/ <br />