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� M <br /> PERMIT APPLICATIGN <br /> Bl�!LDING/MECHANICAL/PLUMBINGISIGNlSPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 425-257•8610 FAX 425-257-8857 �w�rw.everettwa.org <br /> S -�3 -�3 <br /> SITEADDRESS:� � G�1� A PROPERTYTA%a R�O - Z <br /> LEGAL Ior new mnsUuclion Shotl PlaVsubdins�on lol No._ (anach copy ol long legal descnplion) <br /> OWNER �/� � '� � � Q'e, Phoncl6maii 36� -65 $ - �'� 17 <br /> AAOress � CilylSlatc2ip <br /> APPUCANT: Ovmet __OwnCiSAgen1 �Contr3Clor _ConlraCtoi5P9ent _TendM�muncm�aen�enoro�wme,ivommao«nenoaowcn�,nmosDn:el <br /> CONTRACTOR oo. � or,S � c �-. Slate Lic. # V 01 �� Gty Bus. L�c. d <br /> G , p <br /> AdEreSs O � �1C�C�� PhonelEmail �ZS -S.��' ) <br /> TENANT BUSINE55 NAME �v� � p� � CONTACT FOR PERMIT v�('�rn Qv�S <br /> p �- �1l 4J <br /> DAVISCou57R�eT1o�Jin1[ Cd �FoTMAIL Fhene�Em�il �2$'rJ� �— � S',S� <br /> BUILDING PERMIT APPLICA'tION CONTRACT PRICE OF WORK � J J <br /> Existmg Usc of Buddmg _ HEAT SOURCE� <br /> Proposed Use o1 Budding _ Gas_ Eiecuic_ Other_ <br /> Buddmg type _Single Pamdy _Duplex_Townhouse �Muiti-Famdy _Commerual <br /> Type of prc�ect New Adddion _Remotlel Repair T I. _S�gn_Sprinkler_Demolition_Change o(Use <br /> DESCRIPTION OF WORKfaddmona�sPacepro�:dedonrhoDackl. <br /> �tQ\�ac� Qr,1�cy. S�S�15 <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Typu ol Pro�act: _New_Addn _Alteration_Rapalr Typo ol ProJect: _New__Atltln _Alterallon_Ropair <br /> Show Numbcr/u)ollixtures Show Numbcr(qJ ollixtures <br /> NG-air handhng urnts Toilel <br /> Porced a�r systems Bathtub <br /> Gas p�ping lavalory(wash bas�n) <br /> � Waler healer Shower <br /> Gas hrcplace Kdchen s�nk 8 disposal <br /> Gas range Dishwasher <br /> Clothes drycr Clathes�vasher <br /> Ranpc hood Waler heatcr <br /> Ezhaust fan Sink (serncelbadmop/elC.) <br /> Heat pumD Backfow prevrnter <br /> Umt heater I Unnal <br /> � Ooiier � Unnking Fountam <br /> i Reingeration I'loor dram <br /> Woodstovc Grease Irao <br /> Duc�ing Roof drains <br /> Other Medical Gas <br /> SPRINKLER ! SUPPRESSION SYSTEM o�her <br /> Number of Heads Other <br /> I pemCy<en ly IM1ai I�ave ma0 on0 e�am�ned Inrs npp':W'�on antl know Inc sema to�c tme onE mrrcd AA provrsions ol�aws a�U artlmances govern�ng 1n�s IypC ol work x��bo cOmpleA <br /> wln Hnetne�sFeufmO neiein o+nol Tnn g�aniinq ol a ce:m t aces Ool O�esumo la g�vo aWhonty 10��ola!e cr cancel Ine picros�on ol any ot�er stale ar local law regulabng conslmct�on <br /> Teaf I am autnented 6y me owner cl in•s O�o�eny lo penortn��e work Ier wTrli applKabon Is maEe an01 comp�.y w.tn Ine Sleie CoNrecmn Lmv IB 47 fiCW anC]96 300A WAC. <br /> ��fi��f-- `i-Z.S�13 '/z <br /> Ownorl o� etl Aqent Signaturc Date fRevrsea3Rof31 <br />