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I <br /> PERMIT APPLICATION <br /> BUILDINGIMECHANICALIPLUMBING/SIGNISPRINF�LERlDEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett,WA 98201 425-257-8810 FAX 425-257-8657 www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS: PROPER7YTAXp PERMITp <br /> /U °Cfl2c�d e '� WA ��•\ D'O � <br /> LEGAL for new wnstmction: Shotl PlaVsubdrvision Lot No._ (attach wpy ot long legal descnption) <br /> OWNER U�/w�� S � � ^Y� PhonelE-mail C�L- 7�� 22 <br /> Atldress �'� �� �Mf '`// CilYlStalelZip D/}f�/✓IJ! O.�W� <br /> APPLICANT: Ovmer OwnersAgent �'Contractor CANf3GlOr5A9Ef1I _TCf13f1l1muslprorNeaktle�WconsentlromUiewr�ertotlowoainMeapace) <br /> CONTRACTOR CU��GZEC�J � " `jNLC�/✓lL'Tf� L81Lic.# C��[V2�S���ZZ�t COEBuS.Lit.# C0�7� <br /> naaress �fl2v QL�F<< A�C . [���� O Phone/Email 25-Z7Z-3N9 <br /> TENANT BUSINESS NAME CONTA���O�PERMIT <br /> D'(�z�c�ys �+vr� ''�' .,a�A.e� <br /> PhonelE-mail Z� ! MRrl�@ESS <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK .�1"�'� <br /> Exisling Use of Building, e��M�ti�� ��TA((— HEAT SOURCE: <br /> Proposed Use of Building Gas Eiectric_ oiher <br /> Buildinglype: _SingleFamily _Duplex_Townhouse _Mulli-Family K.Commercial <br /> T e of ro'ecl: New Addilion Remodel Re air T.I. Si n S rinkler Uemolition Chan e ot Use <br /> DESCRIPTIONOFWORK(addrtiona�spaceprovidedonmeback): U�An '100� <br /> (�yp�a�� N� 32�1� Zco,oco Brv vN�-r /�c�r2Ks �rrft N� <br /> UlJ i7� I��IZTLS. l.��J UNc�S f'AlI k �055 T`�`"�- 6tdi�� <<wc(� —wc �� �G �iv.vy <br /> � e ,.f,l`� S�3 u�� vtic�'S �C� �N �RrME Gne.rrtn� <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> TypeofProject: _New_Addn _Alteralion,�Repair TypoolProJect: _New_Addn _AltereUon_Repair <br /> Show Number(x)ollixturcs Show Number(a)ol fixmrcs <br /> A/C—air handlin units Toilet <br /> Forced air s stems BatMub <br /> Gas i in Lavato wash basin <br /> Waler healer Shower <br /> Gas fire lace Kitchen sink&dis asal <br /> Gas ran e Dlshwasher <br /> Clothes di er Clolhes washer <br /> Ran e hood Water heater <br /> Exhaust fan Sink(servicelbadmo /etc. <br /> Heat um� Backflow reventer <br /> Unit heater V�AV 2cL» Urinal <br /> Boiler Drinkin Fountain <br /> Retri eration Floordrain <br /> Woodslove Greasc ira <br /> Ductin Rool drains <br /> Other Medical Gas � <br /> SPRINKLER/ SUPPRESSION SYSTEM Other: <br /> Number of Heads Other: <br /> I licrebq ceM1iy ihat I have maE anA examvled Nls apD��lbn antl know Uo same to De W e antl CArtCtI.M provisions al laws an0 ordinances goveminB Ihis type ol work w�ll bo complMtl <br /> wiih whet�er spedGed hemin or nol.The grantmg of e permil tloes not pmsume to Bive aulhomy lo vbWle or cancel t�e pmvision ol any other etate or bcal law reBula�ng wnstruclron <br /> ll�al I am authonze0 by I�e owner ol lhis properly lo pedorm tho work/onMiU�eppGcatbn Is maEn and I eompy�rU I�e Slate Conlraclors law 18.27 RCW anE 296200A WAC. <br /> ��' �YO �� '" /'�Z <br /> OwnedAulhor d entSignamre Date (Revisedfi20f2) I <br /> � ^ <br /> i � <br />