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1 • • • <br /> PERMIT APPLICATION <br /> BUILDINGIMECHANICALIPLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES �p . 1�- 13 <br /> 3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br /> � —oi <br /> SITE ADDRESS: �IO /���� �vEi E���„��3 �ROPERTV TAX p P MIT AO +—. <br /> b d <br /> LEGAL for ne�v construction: Short PlaVsubEivisian_���'f TOLf�J Lol No._ (atlach copy ol long legal description) ^_ <br /> OWNER 'rpA,VIS Jo�E^�S� Phone/E-mail p(� . �j �-µy � . cw+� <br /> nddress � o <L AvE CiiylStale/Zip GvF,�7�; wA 9B2o3 <br /> APPLICANT: Owner O�vnefsAgeM Conlraclm Coniraclor'sAgent TC�2N�m�elp�m�eoaloiterotwnsm�ImmNoownerloaoworkinmospacn) <br /> CONTRACTOR State Lic. p City Bus. Lic. # <br /> Adtlress Phone/Email <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT �Npy H.dt.!_ <br /> PhonelE�mail �IZS 2�/-Wa� w� e ��"' a('c�•C�M <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK� Sg,coo <br /> Existing Use of Building �(Id H@AT SOURCE�. <br /> Proposed Use of Building �k�66 Gas_ E�ectric_ omer X � Q <br /> Ovilding type: �Single Family _Duplex_,Townhouse _Mulli-Family _Commercial <br /> Type ol project: ✓New Adddion Remodel _Repair__Tl. _Sign_Sprinkler_Demohtion_Ghange of Use <br /> DESCRIPTION OF WORK/admnono�spaceprov�dedo�meoack�. <br /> Na� �aec�E <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type ol Project: _New_Addn _Allaralion_Repalr Type ol ProJecl: _Now_Addn _Allerallon_Ropair <br /> Show Number(N)ollixfures Show Numbcr(a)o!IixNres <br /> NC-air handhng units Toilet <br /> forced air systems 6alhtub <br /> Gas piping I.ava�ory(wash hasm) <br /> Water healer Shower <br /> Gas fireplace Kitchen sink&disposai <br /> Gas range Drshwasher <br /> Clothes dryer Clolhes washer <br /> Ranyc hood Waler heater <br /> [xhaust lan Sink (scrvice/badmop/etc) <br /> I�Ical pump ( f3ackllmv preventer <br /> Unil hCdler Unnal <br /> � Boiler Orinking Foun�ain <br /> Refrigera6on Floor drain <br /> Woodstove Grease Irap <br /> Duchng Roof drains <br /> 011icr Med�cal Gas <br /> SPRINKLER / SUPPRESSION SYSTEM I other <br /> Number of Heads I Other. <br /> Ihembytttlityllmlllmvomadanaewm�nedthiSaDt�'K���onan�kno.vl�es;ttnolonetrueandcorren A11D�ovisronsollawsontlortl�nances9ovemin9lhistypeolwoikx�IlOecampl�,etl <br /> w�lh whelher SD��ilie0 hnem or nol The 9ranhng of a permA�oe:nol presume to givv,utlionly lo vrolnle or eaneel I�e pmvivon of any O�OC�51at0 0�IOWI lix requlalmq eonsimction <br /> Tnnl I am aul�ontetl by Ine o+iner c1 tMs pmpeny to petlorm ine woik lor v,hicq applicntion b ma7e anC I eom0ly wnn me Sinte Conhacbrs W«IB 47 RCW an0 296 700A N'AG � <br /> t3 <br /> -� 7//-l3 <br /> Owa uthor' ed Agent Si ,turc Uate l��v�;ad L?DIJ) <br />