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PERMIT APPLICATION <br /> BUILDINGIMECHANICALIPLUMBING/SIGNI�PRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar SL, Everett, WA 98201 425-257-8810 FAX 425-257-8857 www everettwa org <br /> SITE ADDRESS�n/ � G 7ROVfRiY T.Uf II NM�T f — !,� � <br /> O� � V <br /> LEGAI loi new conslructwn Shotl PlaUsubd�vision Lol No (atlacn coDY ol io��g Ie9ai Uesu�puon) <br /> OWNER � Pnone�F-ma�i <br /> Aatlress � /✓ � �� Cny�Statc�Lp <br /> APPLICANT; Owner _Owner'sAgenl . Conlrnclor _ComracloYSAgenl ___ Tenani���v,orae��e'��,n���unnc„i+��+.�e�meo.oM1���no+o��•r <br /> CONTRACTOR Stale Lic N Cd Rus Lic a <br /> Aedress P�aneiEmaA <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> � <br /> PhonMF�mail <br /> BUILD NG PERMIT AP ICATION CONTRACT PRICE OF WORH�5� <br /> EKistmg Use ol Buddmg _ __ HGAT SOURCF <br /> Proposed Use ol8uild�ng (:a� Eiectric___ Olner__ <br /> BudGing type __ Single F�amily _Dupiex_Townhouse _MWb-Fam�ry �Commercial <br /> T pe of pro�ect New Adddion Remodel Repair_T I _Sign Sprinkler Dernolil�on__Chanqe ol Use <br /> DESCRIPTION O�F�WORK IadC�rronai sn��e p�ov�ded on rne bacwl <br /> ���;� f'�'T/�� �J�iQ� �all �nicr�oY <br /> in ZxlS�in0. S�Ct'� <br /> J <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Typo ol ProJocl: _Naw_AEdn _Atleratlon_Ropalr Type ol Pro�oct: _New_Addn _Altontlon_Repsir <br /> Show NumDer�M)of/i.turoe Sbow Number(N)ol li�Nref <br /> NC -av ha❑dnng un�ts 1 odet <br /> Forced air systems Nalhlub <br /> Gas �pm Lavatory(wash basin) <br /> Water healer ShoHer <br /> Gas hreplace KdcAen smk 8 tl�s osal <br /> � Gas range D�shNasher <br /> i GoVies dryr.r i Clothes washer <br /> Rangc houd i Waler healer <br /> F�hausl len S�nk(serv�cc/bar/mopicic) <br /> 14:at pump I Bachllow p�even�er <br /> Un�.t heater Unnai <br /> � H�.�der Urinking Pountam <br /> � Reh�geration Flocr drain <br /> i Woodstove Grease Ira <br /> Duchng Rooidrains <br /> Other I Med�cal Gas <br /> SPRIHKLER / SUPPRESSION SYSTEM I o�her <br /> Number ol Heads � ����e� <br /> I�ere�y cenAy Ipal I Aove iea0 nn��.a�nined IMs epp'ma�cn nn�1,now Ine same la ee In�e u�E corretl FII p�onsiom c�inM end ed nances governmy Inm I�pe ol woA wr'I Ee campaed <br /> r.n�whet�er speo6c4 namn oi nci t�e q�eniinq o�a P«m�Coef nol�rcwme io qrve nN�omy to rro�a'e or uncel i�e prova,on ol n+y olner siate o�iow��aw wqulal:np co�svuchon <br /> Tnet 1 nm aW�or E P.!aw et mn proCeM�o Detorm�nc wo�la wn�cn eDC�����o�rs maae anE i mmON w���ho S�a�e Convanon law IB 71 RC W and 7%700A WAC I <br /> � L <br /> //—/z�'� <br /> rlAuthorited Agant Signature Oate (Ppvrsra 3?OI31 <br />