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PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLl1MBINGISIGN/SPRINKLERlDEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM a � `�� <br /> SITE ADDRE55: ' . ROPERTVTAXp PERMIT/ <br /> 3�3 lru�wn .�.�. ��/ a,� �� �v �z-���a <br /> LEGAL lor new conslructian: Shwt PlaVsubdivision Lot No._ (ottoch copy ol tong IeBal descnption) <br /> OWNER � ci/�J�i- Phone/E-maii d(�� (?� 0.f� el cQ C `�lnCitl•l'UYl <br /> Address " � .R,(JY( �.l.lJ� CilylStale/'Lip � (�(JJ`t• ���2Q�� <br /> APPUCAN7: Owner OvmersAgenl Contrnctw ContmctorsAgent TE110N�mutlponCeekRttolepnsenihonlneoxne�totlawakmNe�pem) <br /> CONTRACTOR � -, Q / ' L L 81 Lic.# JL1Cc /I?x Of COE Bus.Lic.p <br /> Address , � cAs1 �a��z ��'l. 1_/�2L-� l.<..Vi /c�'�� Phone/Emaii ��C.� / � � '�i��3 <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> PhonelE•mail ��� .��.�Ic= ��ow).;�9�- ���n� <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK /l� = <br /> Exisling Uso of Building HEAT SOURCE: <br /> P�oposed Use of Building Gas Elec�ric � Othcr <br /> Buildingtype: �SingleFamily _Duplex_Townhouse _Multi•Family _Commercial <br /> Type of pro'ect: New Addition Remodel Repair T.�. Si n S rinkler Demolition Chan e o1 Use <br /> DESCRIPTION OF WORK(addi�lonal spaco providod on tho 6ack): <br /> l�cr�� ��'�� '�� —� ll?.ci'�L�� <br /> MECHANICAL PERMIT APPi.ICATION PLUMBING PERMIT APPLICATION <br /> Typc of ProJect: _New_Addn _Alteratlon_Repair Type of ProJect: _New_Addn _Alteratlon_Repair <br /> Show Number(A)al flrfures Show Numba(MJ of(xtures <br /> ! NC-airhandlin units � Toilet <br /> I Forced air s lems Balhtub <br /> ' Gas pipin }./ h -;�< � (. ! Lavalo (wash 6asin <br /> — i Water heater� � I Shower <br /> — • Gas fre lace Kilchen sink 8 disoosal <br /> —� i Gas ran e �I Dishwasher <br /> - Clothes d er I Clolhes washer <br /> i Range hood I Water heater <br /> �� Exhaustfan Sink(service/bar/mo /e�c. <br /> Hcat pump I Backflow preven�er <br /> Unil heater I Udnal <br /> ! Boiier I Dnnkin Founlain <br /> i Refri eration Ploor drain <br /> ' Woodstove i Grease tra <br /> ' �uctin I Roof drains <br /> —�/ Other � Mediwl Gas <br /> SPRINKLER I SUPPRESSION SYSTEM Other: <br /> � NumberofHeads � Other. <br /> I heiehy certrty Ihat I hare read and examined U�is epplrcal.on and knmv tl�e same to 6e We and crortect AA provisiuns ol Ia+s and ordinance6 poveming this Iy9e olpvrk xil be co•np�ce <br /> vnh ahmher specRied hemin ar nat The p2ning ol e OeimR does not prcsumt to 6Ne au[hnnry Io vinla:c or canccl;he provision ol any olher s:a1e or local lew regulaUng canscucbo�i <br /> Tnal I am nulha¢e Ey th er dNq prapaty to p dorm the wvk lor v.fiich appicatron is mutle o�tl I comply wiih Ihe Sluce ConlraUors Low 18.27 RCW and 196.700A WAC. <br /> ;' , � , , �/ <br /> , , �, � �� /.� <br /> OwncrlAu odzed Agent Slgnatufe Dale (Revised 64072) <br />