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� � <br /> PERMIT APPLICATION <br /> BUILDINGIMECHANICALIPLUMBINGISIGN/SPRINKLERIDEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.evejettwa.o� <br /> � <br /> SITE ADDRESS: -7 -y� /�,/� PROPERTYTA%p P}��� hQ � <br /> L /�D L�-!°-- i' "" � �� � v� <br /> LEGAL lar new con,truction: Short PlaVsubdivision Lot No._ (attach copy of Iong le9al description) <br /> OWNER � C .SG�y Phone/E�mai� UV J�� lS�J/ <br /> ,�dtlress � � CirylStatelZ�p L���t�� <br /> qPPLICANT:�Owner Owner'sAgeM CoNractor CoMraclofsAgent _TenaN�m�sivronaaaioncroiwnsemnammoowne�ioeowan�nmesoacr� <br /> CONTRACTOR 7�� �V� �S Sta�e�ic. tt 7 PT�l� �b I �ZZ� Ciry Bus. Lic. # <br /> AdAress ��Z� �sr � W/t 9dvv PhonelEmail GrFs 3� ' �b� <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> PhondE�ma�l <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> O � HEATSOURCE-. <br /> Existing Use of�uilding f}G � — . <br /> Proposed Use of Building 5� Gas_ Electnc_ Olher_ <br /> 6vildmg type� _Single Family _Duplex_Townhouse �,Mulli-Family _Commercial <br /> Type of proie��� New _Adddion _Remodel `Repair_TJ. _Sign_Sprinkler_Demoiition_Change ol Use <br /> DESCRIPTIONOFWORK(addrtwnalspacepraiidedonfheback�: � <br /> AD� (�/ts t�iPi,�lh ro flc7�tctf��fl �''�C <br /> MECHANICAL PERMIT APPI.ICATION PLUMBING PERMIT APPLICATION <br /> 7ypo ol ProJoct: New_Addn _Alteratlon_Repair Type ol Projecl: _Naw,_,Addn _Alteralion_Ropair <br /> Show Numbcr(HJ ol lixfuics Show Number(M)0!lixfures <br /> A/C–air handling units Toiicl <br /> � forced air sys�ems Bathtub <br /> Gas piping I.avalory(wash basin) <br /> Water liealer Shower <br /> Gas freplace Kitchen sink&disposal <br /> Gasrange Dishwashcr <br /> � Clolhes dryer � Clolhes washer <br /> RanGe hood Waterheatcr <br /> � Lxhaust fan � Sink(servicelbarlmop/etc.) <br /> Hcal pump � Oack(low preveNer <br /> - � Uml heater Unnal <br /> � Boiler Drinkin9 founlmn <br /> � Rclrigeralion � Floor drain <br /> Woodslove Greasc Irap <br /> Duchn9 Roo�drains <br /> � Olhcr � Medical Gas <br /> SPRINKLER ! SUPPRESSION SYSTEM I Other <br /> Numberof Heads � Other <br /> 1 here�y cenAy thai I�om rcod antl aeinnred Ihi;appliiition and knaw Ihe;amv lo be Ima.nd carrect.All provaions ol taw5 antl orE�nances govemmg I�is tyDe ot work w.N 6e comp�:ed <br /> wA�whelner speciLea ne�ein ar nol 700 9rJNin9 al n pMln:t does nol p�esume to grve nul�orAy ta viol0le or Wncel tllv provrsmn ol.lny olher slalo or local Idw re9ulaling crosimclion <br /> lhal I am aulno' tl Oy Inc owncr 1rf;�mpcity to Dcrtnrm Inc wo�k loi�Mk�app�!wlmn Is ma0e and I mmply w�n mo Slnlc Coniratloro Ww 19 27 RCW ane 796200A WAC <br /> ' - g � zc�y <br /> OwnedAUU�orizod Ayant Sl9naluro alc (Rovised J?O1J) <br />