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�ERMIT APPLICATIO� <br /> BUILDINGIMECHANICALIPLUMBINGISIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3240 Cedar St., Everett,WA 9A201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS: PROPERTV TAX q PERMIT <br /> '�'�� �xo�,y.14 00��3 0'14(o011Op '��j� <br /> LEGAL lor new constmction� Short PlaVsubdivisicn Lot No._ (attach copy ol long legal desctlption) <br /> OWNER W�r.�fJ� Phone�E�mail °i��• �7'i • yW? <br /> ACCress ,J��� T�ITw.wp�,�v �4Y Ciry�Slate/Zip £ �T{ � lV(i/� <br /> APPUCANT: Owner XOwnefsAgent Conirettor ConlraclofsAgenl _Tenanllm�s�pm.�aeaier.eroiromenii:ommco-..nc�rom»on,nmesaam� <br /> CON iRACTOR �•�'�D• L 81 Lic. # COE Bus. Lic. # <br /> Address PhonelEmail <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> • p,��►E�J vow•+ • Hc�E�orxy T 8uuoc4— <br /> ' (�}i7LtHl���JL1 PhonME�mail �110��.(�SS'L • uq,kQ�J�M O� <br /> BUILDING PERMIT /',PPLICATION CONTRACT PRICE OF WORK� ' duo�ET ��(�D'QQQ <br /> Existing Use of Buildmg �F ICE. �pF�C.� HEAT SOURCE: <br /> Proposed Use of Ouilding �A�L ����C.�. Gas Electric_ Otner_ <br /> Buildmg type� _Single Family _Duplex_Townhouse _Mul6-Family �Cummercial <br /> T pe of ro�eci. New Addltion Remode� _Repair T.I._Sign_Sprinkler_DeR-.iitron Change of Use <br /> DESCRIPTIONOFWORK�admhonaispacep�o��deeonmebeckl O� S' � ,�� �a F`�� ��,n�` <br /> Rl�IeVKS1�v OP u�PPO1LE�oOC_ �NC pSFtolt. �� OFPIt.0 1�P4-�. YT�EE.T E�CV�•�nW <br /> A Q.t.'in�l �Pe,et �1.ID 4.�e'P►14i►►G p+.fy4(�. 'W <br /> (►'1r0.dJMytwlt b1 ADDiw�4 S"SDai.ii�o�sr�.1tw10o�.�` �►1.ID �.Ib� F.►�'�E.- C.a�lfl4�( . <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Typo ol Projoct: _Naw_Addn _Alteralion_Ropalr Typo ol ProJect: _Now_Aedn _Altoratio�_Rapair <br /> Show Numbcr(711 o/lixtums Show Number(N)o!fixtures <br /> A/C-av hantlhng unrts Todet <br /> Forced air s stems Balhtub <br /> Gas pipin Lavato (wash basin) <br /> Waler healer Shower <br /> Gas freplace Kdchen sink 8 dis osal <br /> Gas ran e Dishwashcr <br /> Clolhes d er Clothes washer <br /> Range hooG Water healer <br /> E.haust lan Sink(serviceibar/mo /Mc.) <br /> Heat pump 6ackllow preventer <br /> Umt healer Urinal <br /> Bo�ler Drinkin Founlain <br /> Relri eration �loar drain <br /> Woodstove Grease Irap <br /> Ducun Roof drains <br /> Other Medical Gas <br /> SPRINKLER 1 SUPPRESSION SYSTEM Other: <br /> Number of Heads Other: <br /> I here�y cenM I�at l nave read anC e.ammeC tn�s app'�iraiian anE knowtne same to be Ime and conM All Drovisions ol laws anU oN�wnces goveming IOrs rypo o/work w�ll6e complieC <br /> eT,�w�el�er spenGeE Aercm or nol T�e g�anLng ol a pertne does nol presume to qwe aut�arity lo violale or rancel the pmvision oI any other state or Iocal Ww regulating consWction <br /> That 1 am nulnom_eU by t�e owner ol ihis property to petlortn�Ae wo�k lor whiuh oppliuilion Is maEe and I mmD�Y����o Slafc Ccntreaors Law 1B 27 RCW and 256 ZaOA WAC <br /> �� s ��� 1�� <br /> oJi1 e/�y <br /> OwnerlAulhorizod Agent Signaturo Date (Revised 6?072) <br />