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PERMIT APPLICATION <br /> BUILDINGIMECHANICALIPLUMBINGISIGNISPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 96201 425-257-8810 FAX 425-257-8857 www.eve�rel a D9 '� <br /> PROPERNTA%II PE MITR � ,` �y <br /> SITE ADDRESS: L4,�,� �'�4�/�,q,�/,,I A� , o�.v <br /> LEGAL for new conslruction'. Shod PiaVsubdivision — <br /> Lol No.___ (etlech capy ol long legel descriplion) <br /> 0 <br /> OWNER (t�S f��.LLn� Phone/E-mall <br /> 4ddiess Zbr'1"' CLiV1-r'7�'�c� �}✓ Ci�Yl51ale2ip � vi,-+n.e_•,Y <br /> APPLICANT:_Owner Owner'sAgeN �Conlrector �,COn��eC10f'SAgenl _TBneM1���V�anOe�bnerolcomemnomtlww�erioEowMinn'e�G���l <br /> CONTRACTOR c`- <br /> i3:L�..,,� L,iz,- . � State Lic.u/3a�+K b�` 9�► � Ci� Bus.L�c. � <br /> 2 � � � � PhonelEmeil Z�'�� 3��'-�s �� <br /> nddrass S�7'h NL �� c i>�r � �"' � � CONTACT FOR PER�IIT <br /> TENANTBUSINESSNAME ^� ��yc /$2.,« k_S <br /> Phone/E-mail 2�=E' �- �l c•i� " r�- �a <br /> BUILDING PERMIT APPLICA7'ION <br /> CONTRACT PRICE OF WQRK A z �L`� <br /> HEAT SOURCE-. <br /> Existing Use of Building <br /> Gas Eleclric Ol�er <br /> Proposed Use of Building <br /> Duildina;ype� V Single Family _Duplex_Townhouse _Multi-Family _Comme�.^.ial <br /> T e of ro ec� New Addition Remodel Re air �TJ. Si n 5 nnkler Demolition Chan e of Use <br /> DESCRIPTION OF WORK(add�nonai spece provided on tne onckl: <br /> �1 �— '. . <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Typo ol Pro�ocl: _New_Addn _Altoratlan_Repalr Type ol ProJect: _New_,Atldn _Alteratlon_Repalr <br /> SM1ow Number(M/o!/Irfurea Show Number(NJ o/lirfures <br /> A�C-air handlin units � Tode� <br /> � Forced air s slems Bathtub <br /> � Gas pipin� I Lavato (wash basin <br /> Water heater Shower <br /> � Gas Gre lace Kdchen sink&dis osal <br /> � Gas range i Dishwasher <br /> '� Clothes dr er Clothes washer <br /> Ran e hood Water heater <br /> Exheust fan j Sink(service/badmo letc) <br /> Heat pum I Bachllow reventer <br /> Unit heater <br /> Urinal <br /> �atler <br /> Drinkin Fountain <br /> Floor drein <br /> Reln eiahon � Grease tra <br /> Woodstove <br /> Rool drams <br /> Ductin I <br /> � Medical Gas �. <br /> Other i <br /> SPRINKLER I SUPPRESSION SYSTEM other. <br /> � Num6er of Heads ' Other: <br /> I nere�y cenAY Ihnl I hnve iead ona e.an��ned Uue opF�'�al�an en�know Iha�ame to 1ro Irue end mrreci All provisan�al lawf end ortlinencet paveminq I�n typ!ol wOrF w�N G!cBmpYld <br /> v.nn v.net�er fOecArea�em�n or nat The p�entinp cl e pertnA Ooes nol prmume Ia pna aul�o�My to v�olpte or cencel I�e pmvi�wn ol wY olber tl�1�a laal lew�epuletinp conftrudbn <br /> tr�,ai i:rn oulnwixe0 oy Ine owner ol Inif D�openy Io pedo�m ine work lor M+ic�eppiK�tron u me0e enE I comply wn�Ihe St�te Cam�tlat 4w IE 37 PC W enU 2%100A WAC. <br /> �� � �� �, ��� . 3 <br /> i �; <br /> � Uale (ReviseG 3R013) <br /> Owh9dAulhodzod Agant Slgnalum <br />