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� �, , i: '� i ,: 21f"�� EVERG�EE; �iAiE HEAi k AC 1_�. 2�(;; . ' <br /> i <br /> PERMIT APPLICATION <br /> BUILDINGIMECHANICALIPLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar Sl., Everetf, WA 98201 425-257-8810 FAX 425-257-8857 �waw.everellwa.org <br /> APPLICATIONS ARE ACCEP7E0 FROM 8 AM TO 4 PM 7 �-d0 `"� Z <br /> SITEADpRESS: I � fn PROPERiYTANp P MITi! <br /> 10�U(� ISL.hI,t)� Y-t - Z <br /> L[GAL for new conslruclion: Shor1 PlaVsubdivision lol No,_ (�Ilach u�y of lonp iepal aesutplion) <br /> OWNER n PhanefE-mail ;7 I- J I <br /> Addre>s 1 V � � F{ CIiylSlaleiZlp ,Q 't (,l._.�/rp ��, L 33yocp <br /> APPLICANT:_Ownor ,^O+mersAgent �Conlracior Conuaclorsngenl Tensnt(mwit«eebueram,:enie�u,�e•�.K�wa,�wn�Miha:ww) <br /> CONTRACTOR � L&I Llc.it eVQ V a�O 1 COE Bus. LIc.N�u� 5. <br /> AddressoZ1a� �Q, r-1V Vi_1tJL-t�l�J`, P�onelEmiil <br /> TENA T BUSIN�SS NAME CONTACT FOR PERMIT ��L J� <br /> O PhonelE•mall 5 �a 5a-3 i � � <br /> BUILbING PERMITAPPLICATION conTRACTrRICEOFwoRK a�b0 ` <br /> Existing Uso oi t3uilding n HEPT SOURCE: <br /> Proposed U58 0(Buildin{1 rty(�" ' �" Gos Eleclric� Olher_ <br /> �uildmg fype: _Single Family _bupiex Townhouse _Mulll-Famll Commercial <br /> T e ol projecl: _New _Addilion Remodel _Repalr_T.I. �Siqn S rinkler_Demolition Chan e of Use <br /> DESCRIPTION OF WORK fadu�Uare�spacaprovieedonfheback): , <br /> �9.j��w� (�ue 4-la�S `'te�--4� �w��p uti- <br /> 5C� l�us�e <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Typa ol ProJoel: _Now�ddn �Iternllon,_,Ropalr rypa el ProJect: _„New_Addn _Altoralion_,Repuir <br /> Show Num6er(H)o/llxfures Show Num6or fk10l lisfu�ea <br /> AIC-01�hnndlin�units Toital <br /> Porced air s•stems 6a�hlUU <br /> Gas ipinq Lavalory(wnsh bosln) <br /> Water hootor Shov.�er <br /> Gas firo�law Kltchen sink R di� osal <br /> GasranCe Dishwasher <br /> Glolhes dryer Clolhes washor <br /> Rt�npe hood Wafer I�oalar <br /> Exhausl fan Sink �orviceNar/moPlelc.) <br /> Hent pum packnow preventer <br /> Unit healer Urinal <br /> [3niter Drinking Founlain <br /> Rolric orallon Floo�drain <br /> Woodelove Greose Ira <br /> Ducling Raof drains <br /> Olher Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM Olhar: <br /> Numtx:r of Heads 011le�: <br /> I heiaby rnnify�Fat I I�ave read anA ea,�mincd U:s eppGca�ion eM Nnaw Ne aame lo ee Uue anO corlecl.All pm+siona of lew�ond ordlnanee�BOVeminp W s type ot wak vA De comp6ed <br /> �•h whelner epecfred hercin a raL Tho praniinp ot e po�mM aces nol Mesume lo ybe aulhaily lo ridate or carcel Ne prodslotl ol onr oNer alato m bcd lax roeuleGnp conclnwtion <br /> Tlia,I am aulhwewl by Iho ownar of iN�property lo PedOfm U�c Nwk la ntich epplcalbn le made ena I�mp�Y�nl�Ne Sl.le Conlreclorc Luw 10.27 RCW aM 2ea.soM V1AC. <br /> \ <br /> � � � � �l" �q�l `.�- <br /> Ownar/AW horizad Apenl Signolurv Dato (Fovised 620�ZJ <br />