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�ERMIT APPLICATI� <br /> BUILDING/MECHANICALIPLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar 5t., [vcrett, WA 98201 425-257-8810 FAX 425-257-8857 vrwrv�.evere1 twa.org <br /> 6�17 —IS <br /> SITE ADDRESS: �.L� PROI'[IiN 7AK N h71i tt � Q D� <br /> .�y� .� <br /> LEGAL!cr n.w can;truchon- o�t PiaVsoemvisic❑ __�at No_ (attach cooy ol iong ie9al descnauon) <br /> OWNER ���RE � Phor.e'E�ma�l <br /> naaress /DD J� '� � � �3 C,ty/StatelGp� [�f� a � <br /> APPLICANT:_Owr.er _Owncr'sAgenl _Conirac�or _ContratlotsAgent �Tenan�tn�+�v�u.doekr.�ro�mrsemrm-mr�.nvi�ao,._+'.��r�•s;a:c� <br /> CONTRACTOR Te�a�,f V� '�j State Lic. N C�ty Bus. L�c # <br /> Address PhonelEmail <br /> CONTACT FOR PERMIT 5����. A . �uSh�f� <br /> �U�1.,I `V1 �� Phone/E�mail�y�.s 3a �9 � <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existmg Use of�udtl�ng HEAT SOURCE. <br /> Proposed Use ot puild�ng `/ cas_ Eiectnc_ omer,___ <br /> Bw'�tling type� _Sinale Fam�ly _Duplex_Tewnhouse _�9ulti�Family "�Commercial <br /> Type of project. New Atltlition �Remodel _ReDair�T I __ _ Siqn _Spnnkler__Demoiition_Chanqe cf Use <br /> DESCRIPT!ONOFWORK(eddrt�onalspacepmNOedcnMeOack): , � <br /> ylneG�n.� �,4th�.lo ,�-e� T"I . <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Typc ol Pwjed: _New_Atldn Altcration_Repair Type ot PrqecC _New_Addn ,f�Altcration_Repair <br /> Show Numbcr(#)o/Fxtures SAow Numba(N)o/Irxfuirs <br /> A/C—air hantlling units Toilet <br /> fbrcad air syslems Bathlub <br /> Gas p�piny Lavatory(wash basin) <br /> Watei hcatcr Sho���er <br /> Gas hreplacc Kilchen 9nk 8 disposal <br /> Gasrange U�shwasher <br /> Clolhes dryer Gn�hes washcr <br /> Rangc hood Watcr heatcr <br /> Exhaust lan Sink (scrncelbar/moplelc.) <br /> Heat pump Bachllow prevenler(mside bldg) <br /> Umi heatcr Unn�l <br /> 6oiler Dnnking Founlain <br /> Refuycration Floor dra�n <br /> _L_ Nbodstovc Grease lrap <br /> � Uuc6nq Roaf tlrains <br /> --j— Otl�er Medical Gas <br /> SPRINKLER I SUPPRESSION SYSTEM Other. <br /> Number o!Hcads Olher. <br /> I�elebyceRJyl�atlh5ve�ea0��ac*a,':ncdt�:sapplcalro�anOAnowl�PSameto�elrucanECorrect Allprovi5ionioflawia�GarQip2nce5governin_"Is��pCClwo�kwillCCtemp.�c� <br /> wln wM1el�ci;peaEc�nrran cr nol.TTe a�anling ci d perm�l Uoes nol presume lo give aut�only to violate or Wncel Ihe D�onAon ol eny ol�er slate ar�oca law regulabng ConsVutlion <br /> That i am.��ihon:eo Ey ihe owner et ih;s piop�•ny iu pedmm ibe��ork br wRtn appXcalion�5 maCe anC I comply a��in Ne Stale Canlmc;ors law 1B 37 RC N arA 256 700A WAC <br /> �--�-`� � . � a � . <br /> Whor�zetl Agent Signature Uale �itewsed�'7075,i <br />