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. r <br /> PERMIT APPLICATION <br /> BUILDING/MECHANICALIPLUMBINGISIGN/SPRINKLERIDEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 425-257•8810 FAX 425-257-8857 www.everettwa.org <br /> 4w14� i.- vol <br /> SITE ADDRESS: VROPERTV TAX p PERMIT <br /> OG UQ <br /> LEGAL for new conslruclion: Shor1 PlaVsubdivision Lol No_ (altach copy ol long legal Oescnplion) <br /> � <br /> OWNER Q 1. �'� Phone/E�mad Q_ — l 3 Q ,(,��! <br /> AOdress - �Q �/� City/5tale/Lp t/ G� <br /> APPLICANT:,�Owner OwnersAgen� Conlraclor Contraclor'SAgen1 Tenan��mniv�o.ae�kr.era'rananu�omu�ewnv�oeo.atninescam� <br /> CONTRACTOR / Slale Lic. # City Bus.Lic # <br /> Adtlress Pnone/Email <br /> TENANT BUSINESS NAME CONTACT FOR PE II`IT <br /> ,S�G�4�� r-f7�acGGl'o� <br /> PhonelE-ma�l — � �,� '{'( <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK ` �O. _ <br /> Ezishnq Use of Buildmg �DS� 2��� l QX/ HEAT SOUF2CE: <br /> Proposed Use of BuildingQvc��[�o..�—�rGC Gas_ EleclricJG oiner_ <br /> Building type: _Singie Family _Duplex_Townhouse _Multi�Family V Commercial <br /> T pe of projecY. New Addition Remodel Repair__T.I. _Sign_Sprinkler_Demolilio � Change ot Use <br /> DE���QII-t.�0 YV RG(D a�( V�space ps���aea�.on�tn�acx� f �2 � ��!'JG/P d-L "��t P �(.0 [��/ �.{� <br /> 1 �-o �{/L.( /' � <br /> �/C�GM G.�i�P S��P i�c,`� -�w a a�a�E-l���t?rs ��� <br /> MECHANICAL PERMIT APPLICATION PLUMBIMG PERMIT APPLICATION <br /> Type al Pro�ecl: _New_Addn _Alloralfan_Repalr Type of Project: _New_Addn _Alteratian_Repair <br /> Show Number fN)ol6xturcs Show Numbcr(N)ol/irfures <br /> A/C—av handlin units ToJet <br /> Forced air systems I Bathtub <br /> Gas p�ping � Lavalory(wash basin <br /> � Wa1er heater � � Shower <br /> � Gas Greplace Kitchen sink 8 disposal <br /> Gas ran e Dishwasher <br /> � Clothes dryer � Clolhes washer � <br /> Range hood Water healer <br /> Exhausl fan � � Sink(servicePoadmop/elc) <br /> Heat pump Backflow preventer <br /> Unil heater Urinal <br /> Boiler Dnnking Fountain <br /> Relrigeralion � Floor drein <br /> Woodstove Grease trap <br /> Ductir.g � Rool drains <br /> Other Medical Gas <br /> SPRINKLER I SUPPRESSfON SYSTEM Other: <br /> NumberofHeads � Other: <br /> 1 hercOY�enAy Inal I have read and eeBmined Ih6 application anE know I�e same to Oe Irue enC[Artect All provis.ons ol laws anU orEinences goveming I�is lypC ol work wYl be wmpse0 <br /> wAn w�ellter specifeC nerein ornoi.TOe granling ol a pefmil Eoes not peSumc lo give aulnonly lo violale cr canal Ine prOVISKKI ol any olher slale IX lowl law regulaing wnslNqioq <br /> TOat I em authorixetl by Ihe owner ol�his pmpe�y lo pertorm I�e wo�k lo�which apaiwhon rs maae an0 i compry wnh i�e Slate CoMradors law t8 27 RCW anE 796 200A WAC <br /> ����3�zoi� 'lZ . <br /> OwnerlAulhorized Agent Signature Date (Rev�setl3R0f3) <br />