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� � <br /> � PERMIT APPLIC�ITION <br /> BUILDINC'MECHANICALIPLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERViCES <br /> 3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-88:i7 www.everettyra.org . <br /> /LI l`I"07'D�l <br /> SITEADD E33: PROPENTYTA%p PERM�TA <br /> Z r r e �� cv . - <br /> LEGAL far new construclion: Shorl PlaUsubdivision lot No._ (atlac�copy of long legai descr.ptinn) <br /> OWNER �� � �/ LL PhonelE-mail z L{/ � Q <br /> ddmss `L, \/ CitylState/Zip �-�/Pr� � <br /> APPUCANT: �wn OwnefsAgenl Contraa�or ConlraclorsAgent Tenant(nL�ipmwuienerormn.m�i�anmsa.nerioaowon,hin.s�.a�� <br /> CONTRACTOR �— K�' Stati�Lic.11 Cily 8us. Lic.# <br /> dress PhonelEmail <br /> TENANT USINESS NAME ^ CONTACT FOR PERMIT <br /> �' ��[,Q V��� P�anelE-mait � �� ��� � <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK ��BO•dD <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building Gas_ Eiectnc_ O�her_ <br /> Building lype: _Single Family _Duplez_Townhouse _A4ulti-Family ,_Commercial <br /> Type of O�ojecl: _ New _Addition __Remodel _Repair_T.I._Sign Sprinkler_Demolition_Change ol Use <br /> DESC/R�IPT/IO� N OF W ORK(adddianal spac�Ie/provi.dAed on rhe back): /' <br /> G1�+co� �<o� � K V �Tl..�- �dClFGvo✓ � <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type ot Pro�act: _New Addn _Allera[lon_Repalr Typo of Pro�ect: _New_Addn _Alleration_Repair <br /> Show Numbcr(a)of/ixtures Snow NumDer(M)o!Iixtures <br /> A/C—airhandlinqunils I Toilet <br /> � Farced air s slems � Bathluh <br /> Gas pi ing Lavato wash basin <br /> Waterheater � Shower <br /> Gas fireplace Kitchen sink&disposal <br /> Gas range Dishwasher <br /> � Clothes d er � Clothes washer <br /> Ran e haoA Water heater <br /> EMhaust fan Sink(servicelbar/mop/etc.) <br /> � Heat pump BackOow reven�er <br /> � Unit heater � Urinal <br /> Boiler Orinkin Fountain <br /> Refri eration _ Floordrain <br /> Woodslove I Groase frap • <br /> Oucting ' Roof drains <br /> Other ' Medical Gas <br /> SPRINKLER/SUPPRESSUON SYSTEM Olher: <br /> Number of Heads Other: <br /> I AereEy canily Ihat I hava read a�d axamined I�h apD4calbn and knawlhe same lo be We end correcl.Allpmvisions ollar;s end ordinances goveming INs lype olwork vNIOe compietl <br /> wilh whel�er spedfiea hercin o�nol.The gronling ol a pertnd Ooa nol Drorvma l0 9��e aut�ority lo Wolale or cancel Ihe pravision ol any ather slate or local Imv requNlinp conslruclian <br /> Thal I am eNhoiiaed hy the oxner o11Ms prope�y lo pedam I�a worle lor whlcM�ppliwlion�s ma0e�n01 comply w0�Ue Slale Cm��adaa Uw IS.i7 RCW and 2%.200F WAC. �I z <br /> J • �to��c- �rroY� (/� 1 l�sa�a.- �/25�2�� ,_ . ..__... <br />