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�RMITAPPLICATIO� <br /> BUILDINGIMECHANICALIPLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 425-257-8810 FPX 425-257-8857 wv+w.everettwa.org <br /> � .�-IG�-i5 <br /> SITEADDRESS: ` � �G PROPERTYTa%a PRM�i� I <br /> LEGAL for new constructlon Short PlaVsuDdivision Lol No._ (attach copy ot long legal aescnption; <br /> OWNER �' 1L Phone�E-maii <br /> AtlUies, (/I�l . Cily/State2lp ���'� � �i <br /> APPL�CANT:_Ow�C! _Ownei5A9eni Irdt�o� _CoNr0Ci0r'SAgCni _TCnaN(mv�iwcvaeaknardc<vemtomire.nenoeowrvmmeep�url <br /> ♦ y � <br /> CONTRACTOR C SL / State Lic.tt . Y � �j City Bus. Lic.a <br /> Aaaress L �� '.'�{/�� �C ' ��/C/��lT �aL-!/, PhonelEmaii � (,06 ��S <br /> TENANT BUSINESS NA � CO TACi FOR P�RyIJ�/� � <br /> ��"�{' �t <br /> Phone/E�mad �" ,��1 jL � /��J '( �,y(SC{�� <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK v <br /> F�cisling Use of Building HF1�T SOURCE' <br /> Proposed Use of Building Gas Eica�lc O�her <br /> Bwlding type� _Single Family _Duplex_ToNnhouse _Idulli•Fam�ly Commercial <br /> T e ol w ed� New Additinn Remodel Re air TJ. Si n S rinkler Demoldion Chan e of Use <br /> DESCRIPTIONOFWORK(add�tionaispecepmvidee nmebnck): <br /> �V�.- �� � � � � ���'`��S��J <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Typo ol Pro�ocl: _Now_AtlEn _Altorallon_Ropalr Typc ol Pro�oct: _Now_Addn _Alteratlan_Rvpalr <br /> S�aw NumDer p o/flrtures Show NumDer p olllrfurrs <br /> NC—air handlinq unils Toilet <br /> Forced air s stems Bafhlub <br /> Gas i In Lavato wash basin <br /> Walcr healer Showcr <br /> Gas Gre lace Kilchen sink 8 dis osal I <br /> Gasian e Dishwashcr <br /> Clothes d er I CIoU�es washer <br /> R0n e hood Wa�er healer <br /> EKhausl fan Sink scrvice/barlmo /Mt. <br /> Hcat um �ackllow reveMer Inside bld <br /> UNI healet Unnai <br /> Boiler Drinkin Fountain <br /> Refri erahon Floor drain , <br /> Woodstove Greasc Ira <br /> �uclin Rool drains <br /> Othcr � IJedical Gas ', <br /> SPRINKLER ! SUPPRESSION SYSTEM other I <br /> Num6er of Heads Olher: <br /> I he�e6y cen ry L�at I�aue�ea0 an0 e�aminrE Inls aDD��cal�on anE know ine same lo Oe Irue anE cortect.Ali provisions ol tav.s aM orainances govem�ng In��s ryDe o�wo�k wli Ge comp <br /> w,thw!,eine�soec`edhereinor .Tlreg�an9ngolaoertnnEoesnoiC�esumeio9lvea�tinonryloviolaleorwncelNeD�ovsionolanyolnerataleorlowtlawreguWt�ogconstrucbon <br /> lhal I a aut. e y Ne .cr ollhls DropeM�o pedorm thc wod lor wTkh aDV6wUon Is made an01 mmplywilh Ihc S�ate Contractars Law 18.�7 RCW anE 7?6.t00A WAC. <br /> �Z���� <br /> Ow� cr u1 or ed Agent Slgnaturo Date (ReviseC ORO75) <br />