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PERMIT APPLICATION <br /> BUILDINGIMECHANICALlPLUMBINGISIGNISPRINKLERIDEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 982�1 425-257-8810 FAX 425•257•8857 ww.v.everettwa.�g /Z <br /> APPLICATIONS ARE ACCEPTED PROM B AM TO 4 PM ��- <br /> SITEADDRE55: . PROPERTYTA%p PERMII,lt .,n �I <br /> r � J��� i' � <br /> 'LV"� <br /> LEGAL lur new ronstruetion: Short PlaVsuhdivision lot No.__ W����h topy ol long Iegal descnption) <br /> OWNER �'1 �-i%')��.�ti,� � Phonc16mall -,� � � " �,� �� � '- - . <br /> � � r � CII /SlatalZi �'t- ] '�i,:, �/l j ! i '�'��1 � � � � <br /> Addresti I ' { � -� .�r... ! . y P � ; r <br /> APPLICANT:_ _O�mmr _Ovnmr'sA9ent �-,�Connactoi _ContractoisAgent _Tenanti��+�mo.�m,nea�•��rco�,���nmm�Mm.�,�,r.,n,r���.��m.�v�.,:,a <br /> CONTRACTOR ,� ' 'l. ! �� .-' / i� � ' � L&I�ic a �.,"; ' %A �,� � ;ii;i � CO[Bus.lic. a ' � ' ', <br /> _ . , p - I <br /> AdArr.zs �� 'l ! � � ��(� /.� 11. �.f ' �i� �E I : I �� � ; !�1 .. :�� PhonNCnmd . �f `�, �` � <br /> TENANT 6USINESS NAME � CONTACT FOR PERMIT <br /> . , �! . r-i._ �!" .' {� . <br /> � . , l . j j Pnanc�f�m.nl . �r V i- i . - 11 ��-- �- 1 ' �. .i <br /> i <br /> QUILDING PERMIT APPLICA7'ION CONTRACT PRICE OF WORK <br /> Exisling Usc uf Ouddinq _ ___ _— - - <br /> H[ATSOURCE: <br /> P�opusedUseofUudding__ _ Gas_.__ [ixlric._ Other__ <br /> f3whLng typc: _Singlc Family _Duplex,_Tovmhousc _Muiti•Family _Commcrcial <br /> T s ol roccC New Addition _Remodcl _ Rc air_ T.I._Si n __S nnkler_Dr.molilion_Chan e of Use <br /> DESCRIPTIONOFWORK(addrtronalsFacep�ovidedonfhoh�ck�; � � _ .�� . r:-' - r.� � , �.: <br /> � i� J ) i.' ,�1!i\l� �t�� ��� � . /-� ,��- t� �-�-/.' 17`_(� (_� , <br /> _ ,.�I�� 1 , , 5 � . � <br /> � ..r ' ,I , ,'�il��i�;_� , ( ��. �,���- <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> TypeofProJuct: _Now_Addn _Alturation_Repalr TypoofProJect: _,New_Addn _Alleration_Repalr <br /> Show Number(#)of/ixturns Show Number tt)ol�xtures <br /> AIC-air handlin units Toilcl <br /> Forced air s titents I 6athtuU <br /> Gas n�inc Lavalo (wash basin) <br /> Wa�r,n c�otrr Shower <br /> Gas lim�lar.c Kdchen sink&dis osal <br /> Gas ran c Dishwashcr <br /> Clathes drycr CIOIIICS WdtihCf <br /> Ran e hood Waior heater <br /> [xhaust fan Sink(servicelhadmo letc.) <br /> Hr.�l um Backflow revenlcr <br /> Unit hcatcr Urinal <br /> Uoilcr �rinkin Foimtoin <br /> Refri craiion Floor drain <br /> Wnodslovc Grcase tra <br /> �uclin Roof drains <br /> � Othcr __ Medical Gas <br /> SPRINKLER/SUPPRESSION SYSTEM o�ner: <br /> i _ i Numbrr ol Hc�ds Othcr: <br /> Ih��re:;yw�t:'y1h;�Uhavo�cadan�c�amaicdUvs:q.p��wlnnanqAnmvllWsamelubeVuunndmrmd.Ailp�misisuo11im5ando�dmancesgovC:nmgthslypcol�mrkn•.AMcompLnJ � <br /> r:ah whet�cr specJieA hema or not.The graning of a permA does not pmsumo lo give author�y lo vq�te or cancellhe pmvisqn oi any other sinte or bcal Ww requ�almg cunsimUion <br /> t i�:t i am omlmnrc y�ho owncr ol nns proprny ta pedortn Nc wo�tc fm whrh eppl¢alun 6 ma0o and I campy wN�Ihe Smte COMmclors Liw iB.27 RGW and 296.700A W AC. <br /> � d � "�`�� <br /> � � <br /> � � Date fRevised 620121 <br /> � pwncrlAulhor zed ABent Signature <br /> �� <br />