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PERMIT APPLICATION <br /> BUILDINGIMECHANICAL/PLUMBING/SIGNlSPRINKLERlDEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett,WA 98201 425-257-8810 FAX 425-257-8857 wVv,�.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM e� �-a-I � <br /> SI7F •^^^^^^• ` PROPF.HNTAX71 PE MITN _O� <br /> � ,-,„� , � E45f GYQMcI P v—�- • <br /> LF.GAL(or new construct�on�. ShoA PlaUsubtlivision A Lot No._ (a;ta:li r.opy of long lepal tleuription! <br /> OWNER l�t� 0� I�VQJ1rPi`� Phonc/E-mail �{25. 25 - Jme 01� GC • <br /> A�dress Z /-Y{/ . . S7e. 7i� City/State2ip E �y�''�H'.wa�US <br /> APPLICANT:�. Owner Owrwr'sAgent ConUactor ContractolsAgent Tenanlim�ncoro•aeemnaoim.,s�+no-om�x�+�+=�ma=+.,n��rK.oace� <br /> CONTRACTOR L 8 I Lic.# COE Bus.Lia# <br /> Atldress Phone�Email <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> �II' Phone/E-mail � �✓, .'V(�� r "l� l <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK UI� <br /> Ezisting Use of Building HEAT SOURCE: <br /> Proposed Use of Building Gas_ Eiectr�c_ Other_ <br /> Buildingfype: _SingleFamily __Dup�ex_Townhouse _Idulti-Family _Gommercial <br /> T e of pro ect New 4ddition Remodel Re air T.I. Si n Sprinkler Demolition Chan e of Use <br /> DESCRIPTIONOFWORY.(ademo�a�space rovidedontbe6ackJt � R�V � � . <br /> �_ e�o 4ca. Rivv✓Stda 5to��. �os�s <br /> �,,� � a(� 1900 6asr Grou•,nc (�ve • <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> TypeofProJect: _New_Addn _Alterotlon_Repair iypeolProJect: _New_Addn _Alteralion_Repair <br /> Show Numbcr(#)ol lixfures Show Number(N)o/fixWrns <br /> A/C—auhandlin unils Toile� <br /> Forced air s stems Bathiub <br /> Gas pipin Lavato (wash basin <br /> i Water heater Shower <br /> � Gas fireplace Kitchen sink 8 dis osal i <br /> Gas ran e � Dishwasher <br /> Clothes tl er Clothes washer <br /> Ran e hood Water heater <br /> [xhaus�fan Sink(servicelbadmo /etc- <br /> Heal ump Backflow prevenier <br /> Umt heater I Urinal <br /> E3oiler Drinkina Fountain <br /> Refri eration � Floor drain <br /> Woodstove Grease trap <br /> Ductin Roof drains <br /> Other Medical Gas <br /> SPRINKLER /SUPPRESSION SYSTEM Other: <br /> Numb=r ol Heads Other: <br /> I hcicby cenify Ihat I huve eeatl and e xamine0 th�s:+pPlicalion antl Vnw�Ihe:ame lo Ce irue an0 wrtM.M provislons ol lews antl ortllnances BovemMp ihi6 type of work vnll Le eomoFetl <br /> vntli vrliel6cr spenfetl herein or nuL The granling ul a pertnil does nut presume��givc aullion!y lo vblate or rancel Ihe provisbn of any ol�er steta or lo�l law2pulatlnp mnsbuqlon <br /> ll�al l am aulhonrcA by Ihe ovmer ol this pmperty lo Derlorm I�e woM lor vAiicli appl¢aibn is maJe antl I wmpywil�Ihe Slate Conlractor6law 18.17 FCW an01B8 200A WAC. <br /> �lQ.�. /�� ����l2 ���- <br /> OwnedAuthorized Agenl Signeturo Date (Rev;sed 62072) <br />