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• o <br /> PERNiIT APPLICATION <br /> BUILUINGIMECHANICALIPLUMBINGISIGNISPRINKLERIDEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES 6 � �y —�3 <br /> 3200 Cedar St., Evarett, WA 98201 425-257-8810 Fl.X 425 257-8857 v✓vvrv everettwa org <br /> 1�03 'zt �o �r31 <br /> SITEADDRESS: i PROPERTVTA%n P,�gh11T —" ( <br /> I�z} �� l3ro�.itw oZ�3o � (� � �131�(0-� <br /> LEGAL(or new cens'm:ncn Shoh Plavsuoa�vlsion lot No (atlach cepy o1 long iegai descnpuon� <br /> OWNER ����f:(•L �:•''�G�a•:• Pho�:e�[�mail 2.S Z S Z �/Z�6 � <br /> Adtlress I �Z� N . 1J�,9�te�iN( /�✓<�"� wl a� Ci:YlSlalc/Z�p <br /> APPLICANT:xOwner Cwner'SAgen1 Goniractor Conlraeluf5A9ert Tenanll.r��sic�o,�avaiere���co��sr:n��or�n,,,.n�,ne�..�n��me�;�:c� <br /> CONTRACTOR �(i-�l L� �.) ��`���w 'atate Lic n �v ° 3 L�� S� 3/ C:'y C�s L�= # �S�/3� <br /> naaress ��Z, I �L'��L�J '7Nc�-L�f'T �l'/� C(�L� � PhoneiEmal 2{ ZS �$ 2- y2�5 <br /> TENANT BUSINESS NAM17E CONTACT FOR PERMIT <br /> -�'�„� Cr���S Y�f C�f' ��� �C C <br /> ar,o�e�[ ma�i �-I?S Z�2 y�.�� <br /> B111L01NG PERMIT APPLICATION CONTRACT PRICE OF WORK J/A <br /> [x�sUng Use ol f3wld��ng�p r _ �J �F N[AT SOURCE <br /> PropOSCdUSCOfLWildmg��/j[ t�P�r �o-����^ _ Gas_, EIecL�c__ Other__ <br /> Bw'�ding type _Singie Fam�ly _Duplex_Townhouse _Nu!IrPamily y Commercial <br /> TyUe cf pro�ect New _ _Adddion Remodel _Repair_T I._S�gn_Sprinkler_Demolrtwn__ CF.ange of Use <br /> OESCRIPTIf'N OF WORK(acd ncnai spac�pro��een e�me bacwi tj Ui��l� �n �lin L'L� /1� �`�<<^- <br /> ��/� �F 6�,- ¢o �'u f� a � �-��/I <br /> MEGHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type ol ProiecC _New�Addn _Alteralion_Repatr �II�- Typo ot ProjecC _New_AdAn _Alloralion_Repair `UJ�_ <br /> Show Number(u)ollixturrs � � Show Num6cr(N)ol Gr�ures � <br /> AiC-a�r handlmg units I To�'et i <br /> � Po�ced air systems Balhtub I <br /> Gas p�oing Lavatory (wash basin) _ <br /> Vva�ei iieater Sn�wr� � <br /> Gas fireplace Kitchen sink 8 disposal <br /> Gas rangc Dishwasher <br /> � C�othes dryer I Ciothes washer I <br />�I� Hange hood � Watr�n c�a�er <br /> Exhaust fan Sin4 Iservite/bar/mo0�elc) <br /> Heal pump � Backflow prevenler <br /> Uml hcatcr I Unnal <br /> � �odcr Orinking h-ountam <br /> I Keingeralion Flcor dra�n <br /> Wocdstove Grease Irap <br /> � Oucting Rool arams <br /> � p��e� Mediwl Gas <br /> SPRINKLER / SUPPRESSION SYSTEM � O�her. <br /> NumberolHeads � Olher: <br /> I n9reDy cenR/I�at I nave i ea�anE e.eminea Ihis avD'��e!i.^n a�a!ncw Ine;ame to C^_irue a�a corretl All provis•ons ol laws onC orainances governing Inis lype cl work wJl Ce co�p�.ea <br /> wnh wnct�er 5pecfe4 neiein ai nol Tne grenling cf a Fer*n 1 Ooes ncl p�c w're�o'��ve aul�..t1y te viola'e or W nrel Inr piov¢�o���any other slate Cr laal Irp regulatin)CqnsimcLon <br /> T�al i a�r.au:�ouxed by t�e o++ner o11h�5 propc�y lo Oer!orm t�c wort�or w1�.1�sppi cabcn�s ma0e an01 comply Hi1�P+e S�ale CcNradors taw 1817 RCW anE 2P6 700A WAC. 1/ <br /> 7:' S , � <br /> Owncr7Au�horiz AgenlSignal Date �Ree,sod3%;Of�) <br />