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�ERMIT APPLICATIO� <br /> BUILDINGIMECHANICALIPLUMBINGISIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES S ����I � <br /> 3200 Cedar St , Everett, WA 98201 425-257-8810 FAX 425-257-8857 v,rvnv.everetriva org <br /> 13150 -0 <br /> SITE ADDRE55: PROPERTV TA%N P R.11T p <br /> 23 CA m ia Q. c�e.-�;u�a—�IQ2o3 <br /> LEGAL loi ne++consL•ucUon Short PiaVsubtliw5ion Lol No_ (allach copy ol long le9ai descnplion) <br /> O+M1'NER 11WdYo f t m t SC �d yma Y1�)i � } e. PhonelE-ma�l C! �C7'lJ�J7 -��S ��'"�3� 1� <br /> A�aress 3''q � ��y( p� Cily/Slate/Z�p �QyL� �a g d-O <br /> APPLIC.ANT:�Ov:ner _Cwner'sA�Cn! _Corirdtior _ConlfdCb�SAgen1 _Tendol(mn:c'=�oaar'a':�ccnse-"r:nmec.*enoto�:n'nm.spacel <br /> CONTRACTOR D�I �l Slate Lic # Cdy Bus Lic tt <br /> Addres, PhonelEmaJ <br /> CONiACT FOR PERMIT <br /> � Phone/E-ma�� <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK I00�� <br /> Exis:ing Use o'Build�ng_�P/�.t7A�"la��^ _�-�r���� - HEAT SOURGE <br /> Propcsed Use o(Bwltling /1�`'"' I a""^'M I !m� • Gas�. E�eciric_ O�ner_ <br /> 6u�lqmg type �Smgie Family _�uplex_To�+nhouse _Mu%�-Family _Commercial <br /> Type cl pro�ect New Adddron _Remotlel _Repair_T I. _Sign_Spr.nk�er_DemoliUon�Change o(Use <br /> DESCRIPTION OF WORK(adde�ona�space pro�,Ceo on tne vack� <br /> ��wl+ a„ti�, 1-e,� '�� ;�CC�� �� �`e"� PQ` �') . <br /> � <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> TypeofPro�ecC _New_Addn _Alteration_Repair � TypeofProject: _New_Addn _Altaratmn_Repair <br /> ShawNumOcr(a)ollrrtures • ShowNumocr(a)olGxtwes <br /> A/C-av handfing und5 Todet <br /> Forced air systems Bathtub <br /> Gas piping Lavatory(wash basin) <br /> Wate�heate� Shower <br /> Gas hieplace Kdchen s�nk&d�sposal <br /> Gas range Dishwasher <br /> Ciothes dryer Ciothes washer <br /> Range hood Water heater <br /> Exhaust lan Sinh(5ervicB/harlmopl2lC.) <br /> Heat pump BackOwv preventer(inside bldg) <br /> Un t heatcr Unnal <br /> �oiler Dnnkin9 f-ounlain <br /> Reingerahan Floor drain <br /> Woodstove Grease trap <br /> Ductmg Rool drams � <br /> Cther P�Aedical Gas <br /> SPRINKLER I SUPPRESSION SYSTEM olher <br /> Number of Heads Olher: <br /> I�e�e�y cen�ty i�ai I�ave reaE an0 r.amineG t��s epPb�alion anC xnwv�t+e same to Oa ime anU wrreel.All provivons ol laws anC orClwnres govein�ng ibis lype ol woik wHi Ce compnre <br /> v:'n v,netner spec.L•eE herem or nol.T�e g�anhng ol a permA Ooes nct presume l0 9rve eutnonly lo violale or Cancel t11e provision ol uny olller s!ale oi lotdl luw regulaSng consvu:!cv <br /> inai I am awhcnecE�y I�c owner ol mis piopeny to pedarm IOe work lor w�¢h aOD��=���on a ma:e antl I camply wnh Ne State Ccnlractors Law 19 2)RCW antl 296 200A�.Y�C <br /> �;l�-�-�- . o�/���.��- <br /> Ow erl uthoriz dAgentSignaturc Uatc (Revisenai20i51 <br /> �Iz <br />