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• � --, <br /> PERMIT APPLICATION <br /> BUILDINGIMECHANICALIPLUMBINGlSIGNISPRINKLERlDEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 425-257-8870 FAX 425•257-8857 vnvw.everelbn-a.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE AODRESS: PROVENTY TAX p PE MIT <br /> I 9B2o I �438233 0l ' <br /> LEGALIornewconstruclion: ShonPlaVSWtllvision LotNo. (altachcopyollonglegaldescripfion) <br /> OWNER �.��54 jr..loo Pnone�E�mall �K�St'J(� 1C� ,Q C �ji'� n � <br /> Address ��8 IOfSi' AVE SE c��yuia��zp La+CE ST6VtrtilS WA 9825'$ <br /> APPLICANT:xONner __ Ov.*+efsA9ent Conlractor ___ConlraclorsAgenl TenantiT�,siem.�a��azvorm�,o��no,,,aoo.-c�roeo..o.+mr�„�::.,�,�i <br /> CONTRACTOR T$D L 8 I Lic.# COE Bus. Lic.# <br /> Address Phone'Email L ks}� ns �� <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT f�j��g 00 <br /> F,r�- ,�n,,,pre��on� , ��/' r���rj �j�� ' I�il � � <br /> EO�n �.earr� �n ��'�.1CI P�one;E maii �' C011ACCh E /1P_.f- <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORN � � U �� 0 � _ <br /> Existing Use of Building OTrI(Q/ HEAT SOURCG: <br /> Proposed Use of Building�4`� � � Gas_ Elcanc_ ome� _ <br /> Bwlding type: _Single Family _Duplez__Townhouse _Mu�ti•Family �Commcrcial <br /> i pe of pro ecl: New �(Addi6on Remodel Repair T.I. Sign Sprinkler__�emolition Change ol Use <br /> DESCRIPTION OF WORK�edj�j�q�cpar�e��-�eep�dne back): <br /> 6.D�ITIO�J "IO�95��fC1� S�OE POF $�1111.D��-J6 + ItiiTEruoYL 12E1-;oDEI_. � <br /> �5�2 .cp �d�`�� d�� _�2..�,��`��'�,v�-;-`�-�,;,,,;,,i�.i�J:.. . , <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> TypeofPmjecC _New_Addn _Alteration_Repair TypeolProject: _Nuw_Addn _Alteretion_Repair <br /> Show Num6er(p)o!fiinires Shaw Number(p)of fixfures <br /> NC—air handiing unils Toilel <br /> Forced air syslems Balhtub <br /> Gas p��p�ng Lavab pvash basln) <br /> Water heater Shower <br /> Gas Greptace Kilchen sink 8 dispos.I <br /> Gas ranne Dishx�asher <br /> Clothes dryer Clolhes washer <br /> Rangc hood Water heater <br /> Exhausl fan SinA(servitelbarimop/etc.) <br /> Hcat pump �acktlow preventer <br /> Unil heater Urinal <br /> Beiler Drinkin fountain <br /> Refri9eration floor dr,in <br /> Woodslove Grease trap <br /> Ductin Roof drains <br /> 04ier Medical Gas <br /> SPRINKLER ! SUPPRESSION SYSTEM Olher: <br /> Number ol Heads Othec <br /> I here�y urtily lhal l�ave read anE eramir.eE Vus apFP�catian ard Anow f�e same to be true and wned.A110�ovisens ot laws ani)oiEnan<et guvemmg thls type�i wcM mn Ge mrcpFvd <br /> wiin xnelne.r sDecfeC hercin or nol.T�o granbn9 0l a pe�mil Goes nol D�esvne to give uuthorry lo.'mla'e o�cancel ihe provbbn ol any ol�er sta'e or bcal law re9uLei�g m�istmcbon <br /> Tean��/ " eC DY Ue o�5 Gro:CaY lo Oedortn t�o wo�A Ic�xhich.appi CaUon u rra�e anu 1 tomply Ndh IAe Slale Conl'Jtton law 1827 RC W anC 296.'GOA�4nC <br /> Z"Z� '�1`--� , �/Z % <br /> Owner/Authorized Agent SlgnaWre Date IReviseJ GR07.) <br />