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• • � �tdd o n �- <br /> PERMIT APPLICATION <br /> BUILDING/MECHANiCALIPLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 vrwvo.everettwa org <br /> SITE ADDRESS: n�O� ; w /� PROPERTV7A%N �R�11T v -� _OQ � <br /> .G ( <br /> LEGAL for new tonsliucuon Shon PlaUsubdiv�sion Lot No. (allach cepy ol long legal descr�pbon) <br /> OWNER ""(, C l.if� Phonc�E�ma�i ZS � � Z- z �yZ <br /> Adtlress �� (S-Q � � ` �� � � Ciry/SlatelZiP (/C'✓ i� �� � <br /> APPLICANT: Gvner _Crmer'si..gnnt _Contrnctar _Ccnlractor'sAgent _Tenant�a��.�.ir=.ce,��.�ce'cic:�,;c,�•.o�ma:.nc�a:a�.,o+„�.��.:.,..-.. <br /> CONTRACTOR Wr i�i State L�c. # Cdy E3us L�c. � <br /> address <br /> ?lionc�'ema�i <br /> TENANT BUSINESS NAME CONTACT fOR FERMIT <br /> PneneiEmad <br /> BUILDING PERMII' APPLICATION CONTRACT PRICE OF WORK_ <br /> Ex�stmg Vse of E3ui'd;rg HEAT SOURCE <br /> Proposed Use of Budd�ng Gas__ _ Eiecmc_ a�her__. <br /> Bwld�nq type� �Single F`am,yy _Duplex Townhouse _A'ulti-Family _Commercial <br /> Type of proieU e�v 7�Adddion �Remodel _Repair_T L _S.gn_Sprinkier�Demolition_Change of Use <br /> DESCRIPTION OF WORK(�a�i.'�mm�spacepro�rCedonme�a;k): <br /> ���'�r-���� ����. ,.�,f_ <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of PwjecC _ ew_Addn _Alteratian_Repair Type o(Projcct: _New_Addn _Nteralion_Repair <br /> Show Numbcr(a)of IixNres Sho� Numbcr�u1 0l lixfures <br /> � A/C—au handlin9 unds To,lc� _ <br /> � Forcedairsystems � E3athtub <br /> 4 � Gas piping Qul � Lavatory (wash basm) <br /> ��,y�,�_ � � Shower <br /> � Gas lireplace � Kdchen sink 8 disposal <br /> � Gos ran9e f + I Dishwasher <br /> � Clothes dryer Clothes washer <br /> ��K��_ Waler healer <br /> Sink(scrvicclbadmop/etc) <br /> Heal pump � f3ackflow prevente� <br /> Undhe.ter � Unnal <br /> Boder � Dnnkinq Founlain <br /> � Refngeralion � Floor drain <br /> Wootlstove Grease trap <br /> Ducling � Roof drains <br /> � O�her �r1edical Gas _ <br /> SPRINKLER / SUPPRESSION SYSTEM Olher: <br /> Number ot Heads � Other. <br /> 1 ne�eoy ceroly Inal 1�ave�cad anU c.am�ncE I�rs.pp:��i��on anG kno,v U,c samc lo Cc vue anC tormu.Aa pmv�smns o�laws onC ortl�nances 9ovem�ng tn�,s rype cl wo�k H,!I Ce compi�c:l <br /> we�w�e:�er SDe�� e0�ere�n or nU Tnr g�am�ng ol a pennq Caes nol presumc lo g�ve ou��oriry�o violalc or wnccl tnc provizion ol any ot�er stale or iccai lar reguiaunq w�sin,ction <br /> Tnai 1 am auf�or/c ey fhe owne�ol tn�s eny lo Oerlarm I�e wcrk lor w�m�aDD��W��on is maEe BnE I mmply w�ln t�e St e CoNraclors Ww 1B 27 RGW an0 2?6 200A WAC <br /> y�o ao(�n � fee5- d�� � <br /> r <br /> OwnerlAuthorized Agent Signatwe Ddte (Femsed 320i31 <br />