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PERMIT APPLICATION <br /> BUILDINGIMECHANICALIPLUMBINGISIGNISPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM — S '� 3 <br /> SITE AD�RESS: PPOPERTY TAX 71 �' O PERM�N <br /> 6n( 6Co�Vwo t���E q92o� oc,��3£323G3o S �a <br /> LEGAL lor new constmcnon�. Shotl PlaVsubdrvisio� Lot No._ (attac�copy o1 long legal descri0tion) <br /> i <br /> OWNER VJ S � � PhoneiE�maa <br /> A�dress �Q• �� 26aF CQrls 6� Ci�� Ciry� atelZ�p <br /> APPLICANT: Owner O�mer'sAgent CONractor Contraclor'sAgenl _7enanl���s�o�o.��xawc��orta�u��h�+�+ea:^���,��^�^�s�"�'� <br /> CONTRACTUR e '2� S�� ti� �T�S"1 L&I Lic.# S A03La 1� COE 8us.Lic.# <br /> naa�es <br /> �U� (.(.., q`Z us{� �w..�l 41�WA9g2�3 Phone/Ema�Y2�(-i3z5',(o;�le�"�`�ryf�' �• <br /> TENANT BUSINES AME CONTACT FOR PERMIT�� t� LY�nL � �«�' 4ZS-f � I - <br /> w-Q.,�s � � � k ��2u��3�s � <br /> PhonelE�mail �������e -Q�s� H•�U� �1 b <br /> BUILDINGPERMITAPPLICATION CONTRAC7PRICEOFWORK ld+�ro� <br /> Existing Use of Building 1p� HEAT SOURCE: <br /> Proposed Use of Building `�''"�� Gas_ E�ectric omer <br /> Building lype: _Single Family _Duplex_Townhouse _Multi-Family �Commercial <br /> T e of ro'ect: New Addition Remodel Re air T.I. Si n Sprinkler Oemolition Chan e of Use <br /> DESCRIPTIONOFWORK(addrtiona�spaceprov�aedontheback(: � �S`� t D� c��. u��` <br /> (Ze Ikce l w�-�'l s��`.� N•c(�ev4#�..� <br /> i�5.{LJ„� � w �ull Scc�tn S.e�e�K.�'� � .`��� �tA � M{{ <br /> (�ns�� � v��u,,,....w-r sry�1 �� <br /> MECHqNICAL PERMIT APPLICATION PLUM$'iNG ERMIT APPLICATION <br /> TypaofProjecL• _New_Addn _Alteratton_Rcpair TypeolProJech _New_Adtln _AlleraUon_Repalr <br /> SM1ow Number(#)ol!lxtures Show Number(M)o1llrlures <br /> A/C-air handling units Toilet <br /> Forcedairs stems � � Balhtub <br /> Gas pipmg ` Lavalo (wash basin) <br /> Water heater Shower <br /> Gas fireplace Kilchen sink 8 dis osal <br /> Gaa range Dishwasher , <br /> Ctothes drycr Clothes washer � <br /> Ranqe hood � Water heater <br /> Exhaust fan Sink(servicelbarlmo /elc.) <br /> Heat pump I Back9ow preventer <br /> Unil hea�er Urinai <br /> �oiler Drinkin Fountain <br /> Refrigeration Floor drain <br /> Woodslove Grease trap <br /> Ductin Roof drains <br /> � Olher Medical Gas <br /> SPRINKLER/ SUPPRESSION SYSTEM Other: <br /> Number of Heads Other. <br /> I hcreGy certify Uial I�avc rtaJ ond ewmincd Ihis applcalun anC know Ne same lo be Irue and corteU.NI prorisione ot l:nre anC o�0inences goveminB�hia ype ol wwk vnl Ee xmpFetl <br /> wnh whetlier speci6ed�erein or not.Tlia pranling ol o Permil Ccea not presume lo ONe eul�orAy lo violate o�canrel l�e provision ol any ol�er EWIa a local lrv rtqulaling eonslruttiun <br /> lhat I am auNatlzM by Ihe ovmet ol lhis propeM�o pedam 1�evrorle IrnwTirl�applcatron ia made and I cornpyw�th I�e Stalo Conimctaa Lsv 1817 RCW anE Y98100A WAC. <br /> g�, ��{,� 3 - � - �3 <br /> OwnedAuthorizetlAgenl5l�naWro �ate (Revised6R012) (/ <br /> � <br />