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PERMIT APPLICATION <br /> BUILDiiJG/MECHANiCAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everelt, WA 98201 425-257-8810 FAX 425-257-8857 www.evereltwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS: PROPERIYTA%N � <br /> ti 3� 5 �',�� SP,�T A.� �"� - <br /> LEGAL for new conslruction: Shoh PlaVsubdivision Lol No._ (atlach copy ol long legal descriplion) <br /> oWNeP. {�b�7�' !y1 i NNiC �� PhonelE�maii �/L� �7� - C 32'3 <br /> Address L� 31 J C f t'k'�� �� CitylSlatU�Zip ����'� <br /> APPLICANT: Owner OwnersAgenl CoNractor CONracbr'sAgenl _Tenantlm���c��usekimrotcoo.amtromm.o.*rer�oao�wn�na+c.c�� <br /> CONTRACTOR UJ�1"�^ Wtyi� f�UM h��1 � L&1 Lic.#�c t� �v7F�l.�?b7 C C COc Bus.Lic.#�('7/3 7I <br /> Address Z��'�� 5 i.✓ nL��S�t�/ S • �'�����`� �A PhonelEmail <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT �,,;,,p,,I.SailYMLN;SYFL�nfa�.j ,�3iL <br /> PhonelE-mail Z�J� 7� ����7 <br /> BUILDINGPERMITAPPLICATION CONTRACTPRICEOFN�ORK <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building Gas_ Eieanc Other <br /> Buildingtype: �ingleFamily _Duplex_Townhouse ,_,Mulli-Family _Commercial <br /> T pe of ro'ecl: New Addition Remodel Repair T.I. Si n 5 rinkler_Demolition Chan e of Use <br /> ^ESCRIPTION OF WORK(aatitional space pro�dded on the 6ack): � ���`�Qu f� / <br /> ����,.�;2n ��` �p'C G�ti�/ea- �i i v� 3 <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> TypuofProJect: _New_Addn _Alteratlon_Repair TypoolProjecl: _New_Addn _Alteratlon�Repalr <br /> Show Number(a)a1lDrturcs Show Num6er(Ol ol fixtures <br /> AIC—air handling units Toilet <br /> Forced air s stems Bathtub <br /> Gas piping Lavato (wash basin) <br /> Wa�er heater Shower <br /> Gas freplace Kitchen sink&Cisposal <br /> Gas range Dishwasher <br /> Clothes d er Clothes washer <br /> Ran e hood Waler healer <br /> Exhaust fan Sink(service/badmo IetcJ <br /> Heat pump Dackflow preveNer <br /> Unil healer Urina� <br /> Boiler Drinkin Founlain <br /> Refrigeration Floor drain <br /> Woodstove Grease trap <br /> Cuctin Roof drains <br /> C�her Medical Gas <br /> SPRINKLER/ SUPPRESSION SYSTEM Other: /1 � �s'V�i p <br /> Nun.ber of Heads Other: <br /> 1�ercby cenM�hal I heve read and examined ihie aDV�Katbn.r J knmv Iho samo lo ba Irua antl cortea.Ail D���siona ol W�+7 ond orC'�nancee govemhB��ie lypa ol woik w�A 6e comp4M <br /> wAh�Molner spedtretl hereln or nol.iho BranlinB ol o pertnit Joof not presume to BNa nuU�onry lo violale or wncel L�o proaisbn oi�ny aNer eleto or local bw rep W linp conslmciion <br /> That I am authotlzed by IPo mmcr al thb property lo pchorm Uc wotic lorwhkh oppticalkn la madc nna l wmpN��4�Ihc Stala Comracton low 18.27 RCW an0 270.POOA IVAC. <br /> // <br /> �� 1 <br /> �-/'� �12���, • , �"L��- I�> lrZ 1' � <br /> Owner/Aulhodzed Agent Signalure Dale (Rewsed fi�'012) <br />