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� � <br /> PERMIT APPLICATION <br /> BUILDING/MECHANICALIPLUMBING/SIGNISPRINKLERIDEMOLITION <br /> CITY OF EVERET'f PERMIT SERVICES <br /> 3200 Cedar SL, Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa org <br /> SITEADDRESS: � II �ll� d� }�/n,�n PROPERTYTA%u P R3O � Ol,/ <br /> (.1� J� iJlCJfli <br /> LEGAI lor ner�wnslmclion� Shoh PlaVsuOd�vaion lot No_ (atlach copy of long tegai desui�non) <br /> OWNER �Iv � � P�onclE-maii�� � � �e'�C.[//�'/ <br /> Address �u(,l�e C/• GtylState2�P V e l I Q � <br /> APPLICANT:�O�mer _Owner'sAgent Cont�actor ConlractoYSAgent _TenaNl��sipm.�a�aim+e�c�co�:�m meo�..�e�iom.on�n�no�o.,u,� <br /> CONTRACTOR QU � �� State Lic. # �(� �-JQ�S��G� V �ty Bus L�c.# ��� <br /> ACtlress d��D �V10� 5. . �J, V V . e (� /!JL(% Pna eiEff(a���Y !R. � ' <br /> TENANT BUSINE55 NAME CONTACT FOR PERMIT <br /> 5+e"�ebr�h��f2�✓ '3C�� -3�L9 <br /> Phone�F�mail <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORH <br /> Exisling Usc of Budding_ HEAT SOURCE <br /> Proposed Use of�3uilding Gas._ Eiectnc_ _ Omer_ <br /> Budtling lype� v Single Family _Duplez_Tovmhouse _Multi-Pamily _Commercial <br /> Type ol pro�eG�. New Addition _Remodel �Repair_T I _Sign_Spnnkler_Demolition_Change of Use <br /> DESCRIP710N OP WORKladamonaispaeep�o��dedo�rnebacNJ <br /> MECHANICAL PERMIT APPLICATION PLUMBIPlG PERMIT APPLICATION <br /> TypeofPwjoct: _Now_AAdn _Alterr'ion_Ropair TypootProject _Naw_Addn _Alloretion ftapair <br /> S�ow Num6er(a)ol li+fuics Show Numbcr(p)oI fixfurcs <br /> NC-au handling unds � TOJet <br /> � Fo�ced ar systems Balhtub <br /> Gas pipmg Wvatory (wash basin) <br /> � Water healer � Sho�.ver <br /> Gas(ireUlace I K�IU�en s�nk 8 d�sposal <br /> Gas ran9e Dishwashei <br /> ( Clolhes dryer � Clolhes washer <br /> Range hootl Water heater <br /> Lxhaust lan I Smk(servicelpadmoplelcJ <br /> Heat pump I Backllow prevznler <br /> UnA heater i Uonal <br /> � Boder � Onnking fouMain <br /> � Re(rigeration � Floor dra�n <br /> � Wocdstove I Greasc trap <br /> Jucting � Roof drams <br /> Othcr � Metlical Gas <br /> SPRINKLER ! SUPPRESSION SYSTEM I O�her � <br /> Number of Heads � Olher Q Q�" <br /> �,.n vl d5Pv�n <br /> I nere0y ceh�ry�hat 1�eve reaa antl e.amineC I�is appi�wtion anC know I�e same lo�e vue anE conetl.All p�ov�s�ons ol la�5a o�a��;,�«s govem�ng I�is tYM a1 wo��wC e completl <br /> wA�Mncl�cr spcUfcO�e�cin or no1 i�e granLng ol d FC�m�t Eoes not D�csume to gnc outnonly to violdte or wnwl lne provrsion al any aincr slale cr lowl law regulatmg mnzWtlion <br /> IDal I am autnonxetl OY,��e owner ot Ims propeny lo pertorm Ine aorA lar wniU�apD'����on is maa xna i wmpry wnn me siaie Convanon�aw ia n r+ew a,a zss aoon wac. <br /> 'S jzparr �Vo✓!c ee.ds �z7 f� C'�IWl�lefeC//4�S�t,� dl,�e.�v t�e f'/orxP,t�r� �`'D[!�"�.�a.�/r,�s,� <br /> ll1'I�I/1�iyr.P , 0 ��, �)l��/ � C�wice> wiY�, rav✓��e, <br /> erlAu�horizetl Agent Slg uro � (Revised 3/7077) <br />