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PERMIT APPLICATION <br /> BUILDINGIMECHANICALIPLUMBING/SIGN/SPRINKLERIDEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett,WA 98201 425-257-8810 FAX 425-257-8857 �vww.everedwa.org <br /> SITE�\RESS: C \ PROPERTYTAXq3 � OV yOa�O P �I + ' oO <br /> LEGAL lor new conslmction� Short PlaUsuh2ivision Lat No._ (allach capy of long legal desc�iption) <br /> - - 03 <br /> OWIJER ' S � �n Phanc/E-mail c f� /'� <br /> Addre.;s �—l�b �Q G� S � Cily/5tale2ip Q, -v/LL, w ao3 <br /> APPLICANT: +�Owner �Ownefsligent X�Contractor ConlraetoYsA9en1 _Tenanttm�siv«•��eao�e�oimnsmiuom��eo.ne�ioca..o�wnmo,P,a� <br /> CONTRACTOR � Sta�e Lic. � City Bus. Lic.# <br /> f.ddress PhcnelEmail <br /> TENANT9USINESSNAME CONTACTFORPERMIT McirICf1Q W I'tY''e.r'S <br /> (Yl4rlenQc�ti,� i-k-he� S � `� f'nA..iI� COM <br /> Phone/E�mail �}a�j 3� Q <br /> BUILDIMG PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of Bwlding � F 1� HEAT SOURCE�. <br /> Froposed Use of�uilding��_ Gas____ E�ectnq_ omer_ <br /> Bwidmg type 1�Sicgle Famtly _Ouplex_Tovmhouse _Multi-FamJy _Commeraal <br /> Type of prolecf New _Adddion __Remodel _Repair__,_T I _ _9gn__ Spnnk'er Demolilion_Change of Use <br /> DESCRIPTION OF WORK(add:l�ona�spacc provided on rne�ark)�. <br /> REmpvC C—X �S"�ING P,u � 1 D1N�, �p� � rii <br /> '-f' <br /> TO CCr�s� Y2�C� N 6 t�. ; SF �_ � <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Typa ol Pro�ect: _NeN_Addn _Al�eralion_Repalr Typo of Pro�ect: _Nnw_Addn _Alteration_Repair <br /> Shaw Numbcr(A)ol7irtwes Show Number(N)ol lixtures <br /> A/C-airhandlingunils � Toi�et <br /> � Forced air syslems � Oalhtub <br /> � Gas piping Lavatory(wash hasin) <br /> � Water heater I Shower <br /> Gas fireplace I Kdchen sink&disposal <br /> � Gasrange �ishwashcr <br /> I Cl��hes dryer I Clolhes washer <br /> ; Ra�gc hood � Waterheater <br /> � Exhaust lan � Sink(service/barlmop/etc.) <br /> � Fleat pump I BackOo�v preven;er <br /> Um�heater I Urinal <br /> � doiler I Ormking Fountam <br /> � Relrigcration � Floordrain <br /> � Woods�ove Grease trap � <br /> Duding I Roof drains <br /> � Olher � hledical Gas <br /> SPRINKLER I SUPPRESSION SYSTEM � Olher <br /> Num6er ol fieads � Other: <br /> �nereby renJy that 1 hava rcad and e.am�nea:n'u apN�cawn and know i�a snR.e to Oe trve antl mrteU.All p�omions ol la«s and o:tl wnces govemicg tnis type olwoik w:il0e compl�e0 <br /> wa�xlltlner speafic7�ercm or nof.7he granling ol a pertnJ tloes not Fresume to 9ive aulM1onty lo violate or wncel iho pwvb'on ol any cl�er sfalo or Iafal law le9ulaling<onstruction 1 <br /> Thal l am au;norizetl�y I�e owner ol��is pwDeM�c perloim Ihe work Ioi wOrcli appliwuon�5 ma�e anC I compy wah i�e Siam Conlrxtors Law 1B 27 RCW anC 196 200A WAC. `/� <br /> � - � -f �- <br /> Owned uthorizedAgontSignatum Dale (Revrsed3/1013) <br />