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PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everetl,WA 98201 425-257-8810 FAX 425-257-8857 wavrv.everettwa.org <br /> APPLICAT10N5 ARE ACCEPTED FROM 8 AM TO A PM � "� � I <br /> SITE'�,ADDRE55: PROPENiYTA%tl PE 1T11 <br /> �2on� €de✓ " v✓ 5 -, vo y 2 �-DZ<3 <br /> LEGILL for new oonsWCion Shon PlaVwbdrvision ,Lot No._ (attach mpy ol long Iepal aesrnpLon) <br /> OWNER �� Q� 'V� I1 v ��L Phonrh.nal ►J��,/Q1'�✓� <br /> naore•5 3y? S�A t(a/I CW FJ�-�D�f" SC cm�s�,�z�a IZ l. SG � <br /> APPLICANT: Oaner OvmefsAgent ✓Contraaor ContraGofsAgeM _Tenant�mw��owe.ien.+orw�.anr�m�mem..�e�meo.w�mee.o.co1 <br /> CONTRACTOR �A(,IL � 1'}Z1A Q'� L 8I Lic.JJ Tjl1(�L�.�Gq�`'� lp COE Bus. Lic.H <br /> dd�eu ���7"� �� � Sr �7�. � Q d PhonrJEmail 3�p� 7j Z dAl�ti 40L <br /> TEN T U INE CONTACT FOR PERMIT <br /> P�1L1� yDL <br /> PhonPJ[-mail ''.�b0 7� Z �+. yV( <br /> SUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK �°i p0 °o <br /> Exicting Use ol Buildmg SF IL HFAT SOURCE: <br /> Proposed Use of Buildmg s Gas Eiectnc Other <br /> Buildmg type: �Single Family _Duplex_Townhouse �Multi•Family _Commercial <br /> T of ro ecf. New _Addition Remodel Repair T.I. Siqn Spnnkler DemoGtion Change of Use <br /> DESCRIPTION OF WORK(edde�ona�space provieee on rhe back): <br /> � - Qa�� <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT AP►LICATION <br /> TypeolVroject: _Naw_AdOn _Alteratlon,Repair TypeolProjacl: _New_ACAn ,_Alteratlon_Repelr <br /> SAow Num6cr / ol Rrtuies Show NumDer o!fiirtures <br /> A/C—air hanGhn urlts Toilol <br /> ForceO air s stems Bathtub <br /> Gas i m Lavato wash basin <br /> W3ter heater Shower <br /> Gas fire larn IGtchen smk 8 dis osal <br /> Gas ran e D�shwasher <br /> Clothos d er Cbthes was�er <br /> Ran o hood Water heater <br /> Exhaust lan Smk semceJbarlmo letc <br /> Heal um AadOow reventer <br /> Urnt heater Urinal <br /> Boiler Dnnkm Fountam <br /> Relri eration Floor dram <br /> Woodstove Grease tra <br /> � Ductm Roof Arams <br /> Other Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM plher <br /> Number o1 Heads Othor <br /> I hen•Ly opnEy Uai I havn n�a0 and rqrtimnd Mrt ipplration anG 1.nmv tlia s�ma lo M trua nn0 mrtcU.A1 povalons oi qwx an�mivnnws goveminp I�is rypn ol woik vr91 M rompbN <br /> w1tl�whnther r.p!alirA�5rnin nr not ihn grentmg ol a yermA Jom nol pmsumn In pivo autno�by to vpta�n a qn0!I Mo pmN:�on af nny eNe�5tnfb m beil qw rnquNtlnq mnetrt�tlbn <br /> Thxt 1 am numoveC try t rr oI 1�K(uopeny lo pnrform I�o w;4/or wtiM xpptirnlan L m:Ma unU I mmpy wM Mn Sl.rn Lnntradnrq Im�19 77 RCW nnE)nI5100A WAC <br /> � zl IL�I�{ <br /> OwnedAuthorized Agenl Signature Dalc (Rr,visc.15q017) <br />