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PERMIT APPLICATION <br /> BUILDINGIMECHANICALIPLUMBINGISIGNISPRINKLERIDEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org � <br /> �� �--1 � <br /> SITEADDP.ESS: PROPERiYTA%7t P RMITp <br /> Q �D1� <br /> LEGAL for new consWcCiore Shod PlaVsubdivision Lot No._ (attach copy of long tegal descnption) <br /> OWNER � POone/E-mail <br /> Address Ciry/5tate2ip <br /> APPLICANT: O�mer O��weYSAg?N ConUactor ConVacto�sAgent _Tenant(m�r.P�.�ooaicr.e�oiwmem�„m<o.memao.�no,ao:�.,=N <br /> _ — . <br /> CONTRACTOR � Slale Lic.# pvQ p City 8us.Lic.# �n <br /> ntldress /l �' �/ �I rj /l/-elt� `� .t lUTt Phone/Email ?(�j y �pcQ lCl�C ,Cy� <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT n�� �RQ��� <br /> C <br /> � /�� PhonelE�mail� Z "PCI� � ��� �+-� <br /> BUILD�NG PERMIT APPLICATION CONTRACT PRICE OF WORK � m � <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Uee of Building Gas _ Eiectric Other __ <br /> 9uilding rype: _Single Family _Duplex_Tw+nhouse Multi-Famiiy _Commercial <br /> 7 e of ro�ecl: New Addilion Remotlel ✓Re air T.I. Si n S rinkler Demolilion Chanqe ol Use <br /> DESCRIPTION OF W ORK(atladional soace provided on the back : <br /> I��,I�OOi' � �Y,Yvtotr�. �Xil��. (yvl� . �.0 ►'LYJF � �C.X�IS}�t� S"�'V(.�'e' <br /> � �„�y�, ,,�I `�N S�t,t�oLi�wJ S,e.evtv� Iti�,f �`-� <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> TypcolProject: _New_Adtln _Alteration_Repair Typeo�Project: _�ew_Addn _Alteration_Repair <br /> ShowNum6er(A o/fialurns ShowNumbcrl.")o/fixmms <br /> AIC—air handlin units Toilet <br /> Forced air s stems BathWb <br /> Gas i in Lavalo wash basin <br /> Waler heater Shower <br /> Gas fireplace Kilchen sink 8 dis osal <br /> G�sran e Dishwasher <br /> Clothes d er Clothes washer <br /> Ran e hood Waler heater <br /> C-xhausl�an Sink service/badmoplelc.) <br /> Heat um Backllovi reventer <br /> Unit heater Urinai <br /> � Boiler DrinKin Fountain <br /> Relri eration Floordrain <br /> Woodslove Grease tra <br /> Duclin Roof drains <br /> Other Medical Gas <br /> SPRINKLER/ SUPPRESSION ,YSTEM Other: <br /> NumberofHeads Othec <br /> I ncie�y uriify t�al I havc rca�and c.amineC Ihis oD7licilian an0 know Ne same lo he Uue ana cvrtecl.NI pmvisions ol laws and ardiwnce,9oveming Ihis lypc al woAc vri.l bc campl <br /> w,tl�x L1er5pec�fed0eieinurnol.TTegranhngolapermJtloe:nolpm;umelo9iveaul0onrytovblalearcanvellliepmvisionofanycl�erslateorlorallawreguWiingconstruction <br /> iTat auNorcep Uy Ihe owrat al Nis pr p rty Mortn Ne woik brwhi.,h ppGr�tian is rwtle anu I wmpy v.im Inc Statt Conlraclors Law 18.27 HCIN an0 29G 200A WAC. <br /> � ������/^ <br /> Owncr/Au orizetl Agent Signature �ale , � (ReviSed 92014) <br />