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�ERMIT APPLICATIO� <br /> BUILDING/MECHANICAL/PLUMBINGISIGNISP'RINKLER/DEMOLI�'ION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 425•257-8810 FAX 425-257-8857 www.everettwa o�. <br /> �—3G`—/S <br /> SlFE ADDRESS: aROPEHiY iN(p PERMIT# <br /> �VE2 Y��,� i o0 O <br /> LEGAL tor new constmcliort Short PlaVsuOtlivision Lol No._ (attach cooy ol long legal descriplion) <br /> OWNER LE' -��J— '' %�' � PhonelE-mail Zb� g q � C g y <br /> Addn;ss �� � �LM �j � CilylState/Zip ����{J !(J �� . <br /> APPUCANT:_Owrer _O�mcrsAgenl _Contra:�or _Contraaofsngenl _Tenanta�uvponae�ie:i��o+w„c��aamv�.o.-��i�ao�ni.,•n�e�,re� <br /> CONTRACTOR �j�J /l, ���,� �,�/U � �' State Lic. it � 3�' c,.TaT➢F?us. Lic. # 5l� Zc�� <br /> Adaress � f �{'L (, Phone/�mail � �60 <br /> i CONTACT FOR PtERMiI" <br /> 1�t,� c 7 �o�-,c/G- 2 � G y y s 3 0 .� o <br /> PhonelE-mail p/d ��_!�'IX � G�J�O� �o <br /> BUILa'11NG PERMIT APPLICATION CONTRACT PRICE OF WORK � <br /> Existing Use of Building �/ n9 i1?.eJ^Li.4�� � h'EAT SOURCE: <br /> Proposed Use of Building �C3/4�7/�U-F Y[�i.I "Z— �Gas[_ Eiectnc___ oiher__ <br /> 8uilding type: _Sinqle Family _Duplex_Townhousr. Multi•Family ommercia <br /> Type of projecC _New _Addition _Remodel _ R�rpair__ TJ _Sign_Spnnkler_Demolitian_Change of Use <br /> DE�CRIPTIONOFWORK(add�;iona�spaceprvvidedonrhenaca)' • , . <br /> jj� � Zd �- 4 '�( l flS' ..�A- Ct,=c� �o r2 7fo r � �r��✓� <br /> g��' �! � �' X l� � V,�� L ��;� <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> TypeolProjech _New_Atldn _AlteraUon_Repair 7ypeofProject: _New_Addn _Alleration_Repair <br /> Show Numbcr(F�)o!/ixtures Show Num�cr(p)ol fixtums <br /> A!C—air handling units Toilet <br /> Forced air systems �alMub <br /> Gas piping Lavatory(wash basin) <br /> Waler heater Shower <br /> Gas fireplace Wichen sink&disposal <br /> Gas range Dishwasher <br /> Glolhes dryer Clothes washer <br /> Range hood Waler heater <br /> Exhausl lan Sink (servicelbadmop/etc.) <br /> Hcal pump Dack(low preventer(�.nside bldg) <br /> Unit heater Unnal <br /> Doiler Dr�nking Fountain <br /> Refrigeration Floor drain <br /> Woodstove Grease Irap <br /> Ducting Roo(drains � <br /> Other � Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM O�her. <br /> Number of Heads Olher. <br /> I hereCy cetlity I�aI I have reatl antl e.v�mined Ihis appiirvtion and knmv Ihe same Io Cn We anE conect.FII provisions ol laxs anE oidinances goveming Ihis Iype ol wv�A will be wmplieG <br /> w.t�wheNe�spetlfed herein or noL The granting of a pe�m�Goes not p�esume ro 9ive amhor�y to violate or wncel Ihe p�oNsion cl any other state or local l.rv re9utaing conslmNon <br /> T�al I am aulhonzed by I�c oNner of��is pmpeny lo pedorm Ihe wmk for whini aDPLwtion is matlr and I campty wth Ihe S�a:e Canlnctors Ww 18 27 RCW and 296 200d WAC <br /> "�`� a� l�l �/ S <br /> Owncr�etlAg amre T� Da�e (Revised4/t075) <br /> 1lZ <br />