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PERMIT APPLiCATION <br /> BUILDING/MECHANICALIPLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St, Everett, WA 98201 425-257-8610 FAX 425-257-8857 ��✓ww.everettwa.org <br /> SITE ADDRESS: PROPERTY TAl(N PFJy_N T _O <br /> .3 3o w � M <br /> LEGAL lor new construcliorc Shcrf PIaV�u60ivision Lot No_ (atlach copy ol lon�legal Aescriplion) <br /> OVl'NER �c!`5 5 G' Phonel[-mail 7 pZ3`=3 S p ^ �,S/V <br /> Addiess 3� 3 O /ony��,y� : City15�aIcIZ�p <br /> APPLICANT: Owner OwneYsAgent onuactor Conliaclor'sAgent TCfIdM�ruslprrnCo.kce�clrcnseniPomVervne�loaowodinmaspaco) <br /> CONTRACTOR Cp.�. �'7� ,'�C'G/�� `lc� � StateLia # �m [ � il Bus. Lic.# <br /> tiddiess ���C� L" K �� .A L i+ n �G�� Phanc/Email /�'� li) "� li.c.� 4�/�« <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> � <br /> / (Q/L!� L (� PhonelE�mail fM �Q fy�/�/6 j <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of Bwldicg HEAT SOURCE: <br /> Proposed Use of Bwlding _ Gas__ Elecinc Other_ <br /> Owld�ng type�. _Single Famdy _Duplex_Townhouse _M1,�ulli-Fam�ly �Commernal <br /> Type of prc�ecL t�'ev+ ACd�6en Remodel Reparc___T.I. _Sign_Sprmkler_Demoiition Change ol Use <br /> DESCRIPTION OF WORK(avmnonaispacoprcwdedan tde back�: <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> iypcolPro�oct: _New_Addn r,Allcratlon_Repair TypoolPraject: _New_Addn _AHerotion_Repafr <br /> Slrow Nam6cr(a)ol lixfures Show Numbcr(N)o/lixfures <br /> A/C—airhandlingunds 9� h � Todet <br /> � Forced air systems � �alhtu6 <br />� � Gas pipin9 Lavatoi�(va;li basin) <br />, � Wafer heater I Shov:er <br /> Gas fiieplaee � Kdchen sink&disposal <br /> Gas range �ishwasher <br /> I Clothes dryer � Clothes washer <br /> ! Range hood � Water heater <br /> Exhaust(an � Smk Iservicelbadmo0/etc.) <br /> Heat pump I �ackllow prevenler <br /> � Um�hcalcr � Urinal <br /> I 13oiler Unnking Fountain <br /> � Refrigeration j Ploordrain <br /> � Waodstove � Grease trap . <br /> Ducting � Roof drains <br /> � Other � Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM � Other: <br /> � Number of Heads I Olher. <br /> I�ereEy cenJy;hat I hare ieaU and examineC Ihis ap0'��abon an�Anow t�o same lo Oe true an�conect ?il c�or.s ons c!laws ard crcmances goveming��is IYCe olworF wv�be co�Tn'�c� <br /> w.i�x�el�er speclfied herein or no!.T�a gianti.ig el a perm.l dces nol presumo to give awhenly b�mia'c cr oo:cl�ne provisien cl any�Iter sta1�or local iaq reguli�ieg�cns':ecl��n <br /> T�at I am aulhorizea by I�e oxne!oltAn pwDeM Io peRomi I�C work fOf r.TiGh apFLcaLon is.T.+:e an�I ca-�{y..�v�'.i+e 9a�e Co�.trad:�s l a,r 19 77 RCPJ,nd 2^5 7i0i\Y'�f. <br /> �����-'�" //s/y <br /> OwnedAuthoriz dAgentSignaluro Date �r•e:re�ed.t�oi3) <br />