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�� >, <br /> . . <br /> 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 /> SITE ADDR SS: vOO pTM T DIAA/ � PERMMT i I <br /> � r � <br /> LEOAL for new consVuclian, ShoA PlaVsubCivialon Lol No._ (atucb copy al lonp lepal deacnplion) <br /> OWNER a,�ii►+��► Phone/E�maii li Q ` 1� p��-1 �0� <br /> aarecs � ��1�''� � air�si.ierz�o ` I� q � ��s <br /> APPLICANT: Owner Owner'sApenl Conlnctor Contractor�Aqent Tenenll�+�DA��Imumconwnfhwnnen�wrwao.on�nVvap�n� <br /> CONTRACTOR F Sta;a Lic.M Cit 8ue.Lic,k <br /> AGdrefs Phone/Emeil <br /> 415- �qo=N�s� s. wbi� <br /> P�onc/E•mai� � 1�b1� <br /> �UILo1Na �ERMIT A�ILICATION CONTRACT PRICE OF WORK <br /> Existing Use of BuiWing � HEAT SOURCE: <br /> Proposed Use of Bwlding �Gw ,s.F. �� Gas Ebctric Omar <br /> 8uilding type: Single Family _Duplex_Townhouae _MuIN-Family _Commercial <br /> T e ol ro ect: New Addition Remodel Re air T I. Si n S rinkler Demohtion Chan e of Use <br /> DESCRIPTION OF WORK(add�nonar spece providea on the oeckl <br /> N�w S F �Z <br /> MECMANICAL IERMIT ArrLICATION PLNM�ING rERMIT A�rLICATION <br /> Typ�of Pro!�ct: INw_AAEn _Altawtlon_Rapalr Typ�ol ProJecl: New_Addn _Alleretlon_Rspalr <br /> SAow NumDer(I)olllrfur�s Show NumMr �J o/Oxfuns <br /> AIC—alr handlin units Toiiol <br /> Forced air s stems Bethtub <br /> G i in Lavato wash basin <br /> Shawer <br /> as ire ace Kitchen sink S dis osal <br /> Gas ran e Dishwesher <br /> Clolhes d e� Clothes washer <br /> Ran e hood r <br /> Exhaust fan Sink(serviceiberlma letc) <br /> Heat pum Backflow revenler <br /> Unit heater Urinal <br /> Boiler Drinkin Fountain <br /> Re(ri eration Floordrein <br /> Woodstove Grease Ira <br /> Ductin <br /> Olher Medical Gas <br /> B�RINKLER /SU�PRCSSION SYSTEM Other <br /> Number ot Heada Other: <br /> 1�ereDy cenRy Ihtl I A�ve reM snA enmine0 t�u eDW����anC know I�e ume lo W truo and wnetl A1 pmnsion�ol laws and ortlwrces qovertuny��i�lype d v,oA wtll De camq�eG <br /> wIN wMNer�pea�e0�eren or not.T�a qnntiny ol a pamN Cwf nol pre�ums 10 qrvs�uNm�tY�o riolale or uncel tM provbron o1�ny Nher:tate or bwl iaw iegWnhg wrnlmnron <br /> 1�N 1 em W11�aueC Uy N�ovm�r ol lliq ��y�o peAam Ne wak fol wlutli�DDIiGIan b maU��n0 I canply wM IN Sblr Cantractas law tE 77 NC W�n0 t%2f10A WAC� <br /> �� Dc � \ D— 6 � Z <br /> OwnnlAu oriz�AApantSlpn�tu Oate ,� (Revised1�01J) <br />