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�'ERMIT APPLICATIC <br /> BUILDING/MEC��ANICALIPLUMBIPlG/SIGIV/SPFtINKLERIDEMOLITION <br /> CITY OF EVERETT PERMIT SERNICES <br /> 3200 Cedar St., [verett, WA 98201 425-257-8d10 FP.X A25-257-8857 www everetriva.org <br /> PROPERTY TAX N P MIT# <br /> SITEPGDRESS: — ��,J � � �' i /� 2 —O� <br /> � � z_ <br /> LE(:qL fo� new constmctmn� Shon PiaUsvbdrvi;inn Loi No. (a�iach capy ot long lega�tlescnptmn) <br /> UWNER �Q(� ��t�/ Phor,clE-mail �/ �J ' ��L � � �� <br /> nddress y C',(iN�' -�e Cdyi:lateR�p <br /> APPLICANT: O+:ner Ownefs�gem _ConUaclor Comractor's��yent __iena�t;�r���-:�o.�-�nmr�••���^�:�mn_�inoe„��:��n:�.<�.�,�-.,.�,x� <br /> CONTRACTOR �li(J� ���C� . `� State Lic. # �:/� F- G����i Y� us� Lic # (J q <br /> ,.��.. �-,/ �3�� - 7� 7� <br /> Adtlress � Pnone/Emalt ��ZO— � <br /> TENANT BUSINE55 NA�JIi CONTACT FOR PERMIT <br /> Phane:E-ma�l �`�� e <br /> BUILDING PERMI7 APPLICATION CONTRACT PRtCE OF WORK <br /> GxiSUng Us�of Buildmg_ HEAT SOURCE� <br /> Prcposed Use of Buildmg_ _ �as _ Eiectn__ Otncr_ <br /> 9udding lype� _Single Famify _Ouplez_Townhoase _6lulli-Fam�ly _Commercial <br /> TyGe c!pro���ct Ne��v Fddition Remo�]el _Repa'�� _T I S�qn_ .SprinY.ter__Demohtion_Change of Use <br /> DESCRIPTION OF WORK(ay�roona�spa:e pmmded on;ne�nc�.j <br /> MECH.�NICAL PER�f1T APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _Ncr_Addn _Alleration__Rep.ir Type of ProjecC _New_Addn _Alteration_Repair <br /> Show Number(p)o/fi rfures Show Number(#)ol lixfures <br /> ' NC -art hanal:ng umts Tod.et <br /> 1 Forced al�systems 6alhtub <br /> � Gas piping � Laralory (�vash basin) <br /> � Woi^r healer I Shov:er <br /> I Ga� replace Kdchen smk 8 disposal <br /> j Gas�,�nge Oishwasher <br /> � CloUies tlryer � Clathes washer <br /> Ran9e hood Water healer <br /> F.xhaust fan Sink(servicelbadmop/elc� <br /> Hea�pump Backllow preventer <br /> Uml heater � Urinal <br /> BoJer � Urinkiny 1=oun�am <br /> � Relriqeradon I Floordrain <br /> Wnodsbve � Grease trap <br /> DucUng I Rool drains <br /> Olher Medical Gas <br /> SPRINKLER I SUPPRESSION SYSTEM Other <br /> � Number of Heads � Olher. <br /> I ncreby ced.ly b�m I novc rcad anE c.am�,ned s app:���l:o� �ny Yno�..�i��c samc lo be Ime an0 cortM hll pmvaions et laws anC ertliwnces goveming ihis lype ol work x�ll he comphed <br /> wnh wnether spcalied�erer nm i FG;n. .�g ol a p� i aees not p�esume Io grve aulnorny to vlolate or cancel me C�omsion of a�y omer slale or Iocallav.reguiaLng construa�un �' <br /> 7na1 I nm auinonzea Oy 1 .vner !ms �pen� o Ao�m��e work lor xhkli appbcation is ma�e antl I compy wB�Ihe Sta�e Contra�ors Laa t6 P f.CYd anG 24"0 10�A N'AC �, <br /> Owner/ Whorizetl ent Sip tur Dale (Revised 3?073) <br />