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PER�JIIT APPLfCATION <br /> BUILDING/MECHANICALIPLUMBINGISIGNISPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200(:edar St., Everett,WA 98201 425-257-8810 FAX 425-257-8857 www.ever�a�o`g <br /> SITEADDRESS: PROPERTYTA%A PE MITO _O <br /> � � ' i , .�C�iP n o <br /> LEGAL for new consWdion: ShoA PlaVsubGivision Lol No._ (attach copy cl long legal Oescnption) <br /> OWNER f n�-t c. !• I�•r/�� Phone/E-mail �l,) � -�5,�'G (,� �' <br /> Address � � V ' �j� i CirylSlale/Zip �y( (;1� ��s��� <br /> APPLICANT: Owner Owner'sAgenl �Contrector ConlractofsAgent _Tenanl(m�,sipro+�aasioneraconsemrccomecw�enoao,orv.��nme�ra:el <br /> CONTRACTOR ;f�'+i.r : �� � State Lic.# C S�= � Ci1 Bus.Lic.# <br /> Address ��L�+/ �,�{,� 1 /(r� dC5 Phone/Email '��-,j'.,�- �,f.� <br /> TENANT BUSINESS NA E CONTACT FOR PERMIT J��f �1 ,�r C <br /> Phone/Email y � � < r� <br /> BUILDING PERMIT APPLICATION CONTRncT PRICE oF woRrc <br /> Existin9 Use of�uilding Ki���1 ( <br /> � HEATSOURCE: <br /> Proposed Use oF Building - Gas� Eiectdc Other <br /> Building type: ,�Single Famity _DupNz_Townhouse _Mutli-Family _Commercial <br /> Type of pro'ecC New _Additi�n _ Remode� L( Repair_T.L_Sign_S rinkler Demelition Chan e of Use <br /> DESCRIPTION OF WORK(adyuional spnceGrovided on fhe 6ackJ: <br /> MECHANICAI. PERMI'f APPLICATION PL'lMBING PERMOT APPLICATION <br /> Typo of Project: New_Addn _Altoralion K Ropalr Typo uf ProJect: ,_New_Addn _AltoraUon_Repair I <br /> Show Num6er(M)o!flxturas Show Number(M)ol llxh�ms <br /> A/C—air handlin units I Toilet <br /> � Forced air s stems Balhtub <br /> Gas ipin Lavalo (wash basin) <br /> ,y Water heater � Shower <br /> Gas freplace Kilchen sink&disposal <br /> � Gas ran e Dishwasher <br /> � Clolhes d er I Clothes washer <br /> � Ran e hood � Waler heater . <br /> Exhaust fan i Sink(service/barlmopletc.) _ <br /> � Heal pump I Backflo�v preventer , <br /> � Unil heater Urin21 . <br /> I Doiler Drinking Founlain ., <br /> ; Refrigeralion Floor drain <br /> � Weodstove I Grease tra <br /> � Rooldrains <br /> Ducting I M=dical Gas <br /> Other <br /> SPRINKLER / SUPPRESSION SYSTEM i O:her <br /> � IJumber of Heads �I O:her. <br /> I�ereby cendy thal I haae read and e.ammed ihis appi�caUon enC knowtha sama to be Irue end rortecl.AN provisbnn o1la�xs end orEinences poveming Ihis type oi xrork wIA be wmaieC <br /> with»11e�hM specifretl hCrein ol noi.The pranimg ai a pertfl�tice�nol prel�me to One Bulhortly to Nolel!Of cantel Ne pmvlaion ol any o�hef 5tate ar local law fegulafinp Con6iruqion <br /> 7na1 I am emhonzed 6y Ihe owner ol Ini�p�ope�Y�o pedortn t�e xrork torvrtiich app�Kebon is metle anU I compty wtl��he Sta:e Contredon Lew 18 27 RLW enE Z?8100A N'AC. <br /> 1 � / <br /> r /!� /1/.-'�// . � <br /> `4 1�- �� (Revised 32013) <br /> Ow•norlAuthorized Agq dtLro Date <br />