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PERMIT APPLICATION <br /> BUILDINGIMECHANICAL/PLUMBINGISIGNISPRINKLERIDEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM � �a 9'- �Z <br /> SITE ADDRES3: � n VROPERTY TAIf M PERMIT# <br /> �i�'�-4 �t�� e��� C.�� �: ���a.v8-�Se <br /> LEGAL for new consWction: Short PlaUsubdivision Lot No._ (a!tach copy of long legal descnption) <br /> OWNER �Ci Gl I l)Y IV '�C�`� PhonelE-mail `T2�� � ���1 -��� ..7 <br /> nddress �'�l, ���(PS� �C'iLl ✓ cnyis�aterz�p �"��" �����J <br /> APPLICANT: Ovmer Owner'sAgent ConVador ConVadofsAgent Tenanlcm�siro�abneramnsomnom�roa+.wrmao.axa,uwsp�l <br /> CONTRACTOR , �Z1�' �� I� ��.1�t I�b�C L 6 I Lic.# � � ' � ' �4 COE Bus. Lic.# <br /> Adtlress { i L �1�� 1C'211:L4�1 w t� "ri- 1 t1/'f �1� ' an Email �?'Lj 2LjZ- ��U } <br /> N B E � CONTACT FOR PER IT <br /> PhonelE-mail ��� `�' `���L� .. ����.� I��- <br /> BUILDING PERMIT APPLICATION CON7RACT PRICE wORK I t.��� <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building Gas � Electric Other_ _ <br /> Building type: �Single Family _Duplex_Townhouse _Muiti•Fartiily _Commercial <br /> T of ro'ect: ' New Addition Remodel Re air T.I. Si n S rinkler Demolition Chan e of Use <br /> DESCRiPTION OF WORK(atlditional space provided on the back): <br /> I��I����t o�� 11��',�v �''y� 1N�;-I�� ���,��t�w C��� � ) Vefi-a , � <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> TypaofProjxk New_Addn _Alteretlon_Repair TypeofPrqect: _New_Addn _Akeradon_Rapair <br /> Show Number(NI oI fixtures Show Number(NJ o/fixrores <br /> ' A1C-airhandlin units Toilet <br /> � Forced air s stems Bathtub <br /> Ges i in Lavato (wash basin <br /> Waler heater Shower <br /> Gas fire lace Kitchen sink 8 dis osal <br /> � Gas ran e ' Dishwasher <br /> ' Clothes di er Clothes washer <br /> ' Ran e hood Water heater <br /> Exhaust fan Sink service/badmo /elc. <br /> Heat pum BackFlow reventer <br /> Unit heater Urinal <br /> Boiler Drinkin Founlain <br /> Re(ri eration � Floordrain <br /> Woodstove � Grease trap <br /> � Ouctin ' Roof drains <br /> Other � Medical Gas <br /> SPRINKLER / SUPI�RESSION SYSTEM Other: <br /> Number ot Heads �� Other: <br /> I here�y cendy Iliat I Imvo rentl antl ezamineE Nis appiici6on and know tl�e same lo Ee Uua an0 cortect.AR provisions ol laws enG oNinances govemng ihis rype ol woAc wil Ge comptieC <br /> wi1�whether speuf�U herein or nol.Tha granlmg o�a pe�rtnrt axs nol pmwme lo giva auNor�ty lo violale orcancel the pmvision ol eny oMer slaie or bcal law reguWung construdion <br /> Tha�1 am autliwlzca�oy t�e ownm ol Inis pro\lo peAO�m Ino vrork b`v�iG�eppNfaOon 6 mada Hnd I CAmply wBh Iha Sla�e ConlraGors Lew 1827 RCW en0 296.200A WAC. <br /> I � /' <br /> . �'�\ ,'�: /��� : J ��� � <br /> OwnedAuthorited Agent Signatum! `� Da �I L (Revised 6201T) <br /> l <br />