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, . �o I�C�[��M[� , <br /> , I� � ��, ��� <br /> U 11 ,i;,; u 1 ,3 <br /> PERMIT APPLICATION � `v <br /> BUILDINGIMECHANICAL/PLUMBINGISIG�ISPRINKL��MOI.ITION <br /> CITY_QEEVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett,WA 98201 425-25i-8810 FAX 425-257-8857 www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED PROM 8 AM TO 4 PM <br /> SITE ADDRESS: PROPERTY TAX N PERMIT M�. <br /> 11862 CIiE�ca �E� S,k o� oc�kN� �vu�3o3 c;�- f:c> <br /> LEGALfornewconslmction: ShorIPlaVsubdivision _Lo1No._ (attachcopyolloo9legaldescription) <br /> OWNER /��06K �3 PnovkarreslL�G PhonelE�mail <br /> Atldress�j �'l/�VJt.'�JE� l�� _ � Cily/Stale2ip EA�L� wQ I <br /> APPLICANT:_Ovmer Owner'sAgent V Conlrador _Comractor'sAgent _Tenant�m�sio�a�eatece�ohonsemnam�ec.�ermao���on���mespace) <br /> CONTRACTOR 516�15 �LUt L&ILic.# S�iu/aS�lS53Lw COEBus.Lic.# <br /> 3bo-G��•7/Gt <br /> Address 66 M.dRIn�F � ✓L' eL���+CNAM w� �l82� G PhonelEmail . eNt <br /> TENANT BUSINESS NaME CONTACT FOR PERMR <br /> /�rr�ao �GGS SAwts' AS GGu7QAC'f0/L <br /> PhonelE-mail <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK '— <br /> Exis�ing Use o(Building F2CTA 1 L HEAT SOURCE: <br /> ProposedUseofBuilding�t�lO/�- Gas_ Eieuric_ otner_ <br /> Building type: _Single Family _Duplez_Townhouse _Multi-Fam�ily�Commercial <br /> T pe of pro'ecC New _Addition Remodel _Repair T.I. Y Si n_ Sprinkler Demolition Chan e of Use <br /> DESCRIPTION OF WORK(additional space provided on fhe back/: <br /> 1N�A �` ?'wo fl� SQTS uF C��P N�'k�. 4ET'r�Qs <br /> MECHANICAL PE RMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> TypeofPro�ecl: _New_Addn _Alteration_Repair TypeotProject: _New_Addn _Alteretlon_Repair <br /> Show Numbe�I#)o�fixlures Show Num6er(tt)o//ixtures <br /> A/C-air nandling unils Toilel <br /> Forced air s slems Balhtub <br /> Gas piping Lavalo (wash basin) <br /> � Water healer Shower <br /> Gas fireplace Kitchen sink 8 disposal <br /> � Gas ran e Dishwasher <br /> Clothes dryer Clolhes washer <br /> Ran e hood Water healer <br /> � Ezhausl fan Sink(servicelbadmopletc.) <br /> � Heal pump BackOow preventer <br /> Unit healer Urinal <br /> Boiler Drinkin Fountain <br /> Refrigeration Floor drain <br /> Woodstove Grease trap <br /> Ductin Roof drains <br /> Olher Medical Gas <br /> SPRINKLlR/SUPPRESSION SYSTEM olner: <br /> Number ot Heads Other: <br /> I hereEY�Y tl�el l luve roaE end e�mMC � eV�/P / rM kmw ' tertie b Oe true aM cortecL N D�wbbnt dW.s rM ordiwiw�OwsNq nY�YM dwak rA M canDME <br /> witM1Kh¢I�erSpecifieC�ereinOrnol.T/hBQrantlngWe�ertniitloe• �io msumelo9iveaut�onrytoviolaleorcanceltheprovisbnolanyot�erstateorlocalWwregWatin9conswc0on <br /> Tnat I am authonzetl�y lhe ohner o{tnls prope SflPedortn Me qa lornhich applkaiion 6 matle anE I comply wit�the 9ate ConUa:tors Law 1027 RCW and 296 700A WAC. <br /> �-_���_�� ��i/��� (f� <br /> OwnerlAuthorized Agent Siynatu� ' / Date (Revised 6/20f2) <br />