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PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBINGISIGN/SPRINKLER/DEMO�ITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www•eve jettv✓/39 / <br /> , , / PROPERTY TAX p PF,f2MlT# <br /> SITE� DDRE�r, �,�Jl�, �/PCI� VV � . �' ^ <br /> 7 <br /> LEGAL for new conslruction: Shart PlaVsu6division <br /> Lot No._ (allach copy of long legal tlescription) <br /> �1 � ��� L�L phonelE-mail <br /> OWNER �S CU � I'—C� <br /> CirylSlate/Zip <br /> Address A' <br /> APPLICANT: Owner Owner'sAgent _,Contraclor s CONf8c�0i5AgC�� �TB�anl(mustpmviaeatetterolconsemtmmmoa.vnenoeoworkinmespaca) <br /> G L C S�ale Lic.# CC `��I C�h/1'''1 L�C aty B°S. �'�. # <br /> CONTRACI'OR �.�� �i��L -�/7 -03 <br /> /��� `A �fPe �` 1�7�' � `/1(�i Phone/Email <br /> Address �� <br /> TENANT BUSINESS NAME CON CT FOR PERMIT <br /> �(�� l�� l�/� � s��d0 + Phon Emlail �oNZutn N7b� -c� � � <br /> BUILDING PE MIT APPLICATIOrI CONTRACT PRICE OF WORK OO' — <br /> � �,�r� HEAT SOURCE: <br /> Existing Use of Building L�� U�— -- <br /> Proposed Use of Building <br /> Ly�✓�� �� CL,Gb, Gas_ EleUric_ Olher_ <br /> Building type: _Single Family _Duplex,_Townhouse _Multi-Family �Commercial <br /> Type of projecl: _New _Addilion _Remodel __Repair_T.I._Sig Sprinkler_Demolilion_Change of Use <br /> DESCRIPTION OF WORK(additionel spaceprovlded on Ihe back): <br /> ��-� 5 �-�.�� `7 i�G^ <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> TypoofProJact: _New_Addn _Alteralion_Repair TypoofProJocl: _New_Addn _Alleratlon_Repalr <br /> ShowNumbrr(#)o/flxtures <br /> ShowNumbei(N1o/llxfures � TDilet <br /> � A/C—air handling unils � Balhtub <br /> � Forced air aystems � Lavalory(wash basin) <br /> � Gas piping � Shower <br /> _ � Water heater I <br /> Gas fireplace Kitchen sink&disposal <br /> � Dishwasher <br /> � Gas range � Clolhes washer <br /> I Clothes dryer � Waler heater <br /> � Range hood � Sink(service/bar/mopletc.) <br /> � Exhaustfan � Backflow preventer <br /> Heat pump � Urinal <br /> � Unil heater � Drinking Fountain <br /> � Builer ,� Floor drain <br /> � Re(rigeration � Grease trap <br /> Woodetove � Roof drains <br /> DucD:�� _ � Medical Gas <br /> � Othc-r <br /> SPRINKLER I SUPPRESSION SYSTEM � other: <br /> Num6erof Heads � Other. <br /> I hereby cenily thet I havo read antl ezamined Ihis application antl know t�e same lo bo Irue ond corred.P.II provisions o�laws ond ortlinances goveming Ihis typo of work vn!I be complietl <br /> wdn vrhelher specifetl herein or not.The graMing ol a permd tloes nol presuma to give authority lo violate or wncel t�e provision af uny other sta!e or lowl Imv reguleting conswction I� <br /> That I a � aed 6y t�e owner ol lhis propeM1y to perlortn Ihe work fot wh��h appliwlion is made antl I comply with t�e State Conlrectors Law 78.27 RCW and 2962�OA WAC. �' <br /> � �✓t � " ' �- �C�" l� . <br /> O arlAuthorizodAgantSignaWm <br /> Date (Revised 3R073) <br />