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PERMIT APPLICATION <br /> BUILDINGIMECHANICALIPLUMBING/SIGNISPRINKLER/DEMOLITION <br /> CIN OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 wuvw.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITEAODRESS: PROPENlYTA1(p P RMITN <br /> a�t i �„ e�- a4oszoao �rovyoo - ,yo3-aob <br /> LEGAL lor new mnsWqion� Short PlaUsubdrvis�on Lot No._ (ariach copy of long Iegal tlescnp6on) <br /> OWNER{�QLk Bfa$. �1"1��5 PhonelE-madq�'ZQO Z 29 'celehaackbaH�sCdM <br /> Address Z g�� rf`4. �E CitylStale2�P � SV i �� wr► � 9 t�a <br /> APPLICANT: OHner OwnersAgent �Contractor ContraclorsAgenl Tenantim�po.+aeai�r:ra��i�u,eo.,�rroao.uR+,e,e.o�1 <br /> CONTRACTOR Q Q�k B f0 S• C�ol'V�t'T L 8 I Lic.# GCIC [;�U�Z 'Z COE Bus.Lic.M <br /> AOOress3 {2,� g,+� 11�. u� (Ylur Sv�lle Q4ZZo PhoneJEmail ,(�` �QQ��Dfb�P� fW"� <br /> TENANT BUSINESS CONTACT FOR PERMIT Z4 tl_Z y Z 9 <br /> 5uel N aqc� 9Zs- <br /> P�onrJE-mad <br /> BUILDING PERMIT APPLICATION CONrRACT PRICE oF WORK � 3� ( �L �/ <br /> Existing Use ol Building HEAT SOURCE: <br /> Proposed Use oi Building �F� Gas Etectnc_ Omer <br /> Buildingtype: �,SingleFamily _Duplex_Townhouse _Multi•Family _Commerciai <br /> T of ro ect: New Addition Remodel Re air T.I. Si n 5 rinkler Demolilion Chan e oF Use <br /> DESCRIPTION OF WORK(adertiona�space pmvided on the eack): <br /> NeW S � c.vi� A�elc�e� �c� rqye <br /> MECMANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type ol Pro�ecl: �New_Addn _Altenlion_Ropair iype ol Prqect: x New_Addn _Alterotion_Repair <br /> Show NumDer(/J ol firtures Show Number MJ ol fixtures <br /> AIC—airhandlin units Toilet <br /> ( Forced air s slems a Bathlub <br /> Gas pipin Lavalo wash basin <br /> Water heater Shower <br /> � � Gas fire lace / Kitchen sink 8 dis osal <br /> � Gas ran e Dishwasher <br /> / Clolhes d er Clolhes washer <br /> Ran e hootl Water heater <br /> Exhaust(an Sink service/bar/mo letc. <br /> Heat ump BackOow reventer <br /> Unit healer Unnal <br /> Boiler Drinking Fountain <br /> Refri eretion Floordrain <br /> Woodstove Grease trap <br /> Ductin Roof drains <br /> Other Medical Gas <br /> SPRINKLER I SUPPRESSION SYSTEM otner: <br /> NumEer of Heads Other: <br /> 1�emEy cenEy Ilial l llave�eaE anU e.aminM Nis ap0�'�4on ana knowMe same to De Irue anO mned.AO pmvisions of qws anU aWnances goveming inis rype olwark wdl De mmp6eE <br /> wil�wOelAer spMfieE�emin or not,iTe granleig al a perm�tices nal prewme to grve auNorXy to vbL�le or cmcel Ne pmvision ol any other slalo or bol law mgulating mnSWtlbn <br /> TTaI I am auNomeU hy Ne owncrol Ihis pmperty lo perlo�m Nc hoh for wnii�appliratron a maCe ana I mmpN���e Svle Conbadars Law 1827 RCW anE i96.Y00n Wp� <br /> L � <br /> _,2_, y <br /> Own I u horized A t Si Date (Revised 620f2) <br />