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� <br /> PERMIT APPLICATION <br /> BUILDINGIMECHANICAL/PLUMBINGISIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 320C Cedar St., Everett, WA 982D1 425-257-8870 FAX 425-257-8857 www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS: # PNOFEHTY 7AX a P RMIT ,./� <br /> ��g EQLREEN 4iAY I DOM�I3 OUy '130 ' w <br /> LEGAL lor new co�stmc��on�. Short PlaUsuDdlnson Lot No. (aUac�coOY cl long Ivgal de;criplion) <br /> OWNER Q��6�3i PQoat PhoneiE-mail —� <br /> naaress 7yS 9Ft�Ev�F AVc t #��2 c�cY�su�erz�o $�EA1TLf wA q $1 dZ <br /> APPUCANT: O'nner QnneisAgent Conlractar Con:raclot;Agent Tenanl�m�,s:Pm�.aeaeem�o'cec�m'mmceo.�ar�ao.en.n;�esoam� <br /> CONTRACTOR /G ✓ L 8 1 Lic N S/(,,u �/S�-L u COE Bus. Lic.#DYZ7 E <br /> ACtlicss /�j1'1bQ/NE�QI V� � Pr�one�Emaii 3bG' h-1�'7� � <br /> TENANT BUSINESS NAME GONTACT FOR PERMR <br /> �IJST SMIL� 1�'��KE L/I�EBFIn�K JS�CNS PGvS <br /> DENTAL Phwe,'E-mall7�o-(,7�.7/ .aS Lo <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK_ 7OQ� � ' <br /> EwStingUseo(Builtling tuic�c HFPT"�IRCE� <br /> Proposed Use of 9uilding SA�"�F Gas _c__ omer <br /> Buildirg rype: _Si���e Family _Duplex_Townhouse _Multi-Family�✓Commerual <br /> T pe of pw ecP. New Adtlilion Remodel Repair T.I. ✓Si n Sprinkler _Demolrtion Chan e of Use <br /> DESCRIPTION OF WORK�addrtiona�sn���v��'�ded o�u�e oarw): <br /> �J�TALL ONE Ss'7'� CNANti F�-LcT i L-�S ��� <br /> MECHANICAL pERhl1T APPLICATION PLUMBING PERMIT APPLICATION <br /> Type o�Project: _Hew_Adtln _Alteration_Repair Type of Pro�ea: _New_Addn _Alleratian_Repair <br /> Show Number(A)o!fixlures Shaw N�mber(�)o�firfurcs <br /> NC-ah handling unils Toile� <br /> For[edair> Stems Bathtub <br /> Gas p�pin Lavdfo (�sh basin) <br /> Water heater Shower <br /> Gas fireplace Kitdien sink 8 disposa� <br /> Gas rangc D�shwasher <br /> Clo�he5 dryer Clo�he5 wa5her <br /> Range hood Water healer <br /> Ezhaust L,n Sink�servicelbadmopletc.) <br /> Heatpump BackAow preveNer <br /> Unil healcr Urinal <br /> Ooilcr Drinkln PounWin <br /> Rcln cration Floor drain <br /> Woodstove Grease Irap <br /> DucUn Roof drains <br /> Olhcr Medical Gas <br /> SPRINKLER/SUPPRESSION SYSTEM otner. <br /> Number ol Heads Other: <br /> I I�empy tbtdy L�ei I INw maE mH emnMC ' m 4nw Ne slme lo Ea Cln�E cared.P➢D�ovhinf al bwa BM aEhxte�Oac�N�O Ne NM d vaAVA De cwr�leO <br /> wiT wrCMer sreu�ed�erein or nol TTe nLn a pertnli n es nol presume�o gve au�or.ry to vlolile or wncel Pe orm+sno o�any otMr SIaM or bWl Nw reOuLtimg coasN¢M1on <br /> That I am avtiw�ea Dy Ne owner is�ro m pcAorm c�wA foi�Nian apokamn s mad?an01 compy•.nn pie 9ate Con:atlors Lsv�B 17 RCW an0 29fi 700A\vAG. <br /> �i y <br /> OwnedAuthor e Agen ature ale (Revised6/20f2) <br /> ��� <br />