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PERMIT APPLICATION <br /> BUILDING/MECHANICALIPLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES � <br /> 3200 Cedar St., Everelt, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br /> SIT€ADDRE�SS PROPE�LTYTA%p PERMITA <br /> 5a/G cJf/IE7 �G�� oa� 93m� 3boo/Gu _ L <br /> LEGAL for new wnsiruction: Short PlaVsubtlivision_ Lol No._ (aitach copy ol long legal descnption) <br /> OWNERJyI[�/G� I GI/Ilt�c-� C PhonelE-mail �/2� j!T ZS33 <br /> Address 5�1�G�.�/.iAK'L/L l�� Cityl51aie2ip G'f�If� G!/� ��82D3 <br /> APPLICANT: ✓Owner Owner'sAgenl _CoNractor CoNraclofsAgenl Te�e��(musi?mroeaienero�consem�mmmoaanermaawoMmmaspace) <br /> CONTRACTOR � �/ �r� i Stale Lic.# Ciry Bus. Lic.# <br /> Address PhonelEmail <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT Dq/ �/L <br /> PhonelE�mail �Z � i J � � �3 � <br /> BUILDING PERMIT APPL,ICATION CONTRACT'RICE OF WORK <br /> Existing Use of Building 1�K. HEAT SOURCE: <br /> Proposed Use of Building Gas_ Electric_. o�her_. <br /> Building type; _Single Family _Duplex_Townhouse _Multi-family __Commercial <br /> Type of project: _New _Addilion _Remodel _Repair_,T.I._Sign_Sprinkler_Demolition_Change of Use <br /> DESCRIPTION OF WORK(atlditional spece p�ovid�d on fhe back): <br /> /G'a�A/�I����I� �'� G �i��'/i�GC�� ���� <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Typo of ProJocl: _Now_Addn _Alturatian_Repalr Typo ol Project: _New_Addn _Altoretlon_Repalr <br /> Show Number(N)o/lixtures Show NumLcr(NI of/ixtures <br /> � A!C—airhandlingunits I Toilet <br /> I Forced air systems � BaihWb <br /> Gas piping Lavatory(wash basin) <br /> � Water heater I Shower <br /> Gas fireplace I Kilchen sink&disposal <br /> I Gas range I Dishwasher <br /> i Clothes dryer Clolhes v+asher <br /> Range hood I Water healer <br /> Exhaust fan ! Sink(service/bar/mopfztc.) <br /> Heat pump I �ack0ow prevenler <br /> � Unii healer Urinal <br /> i Boiler Drinking Fountain <br /> I Refrigeration i Floor drain <br /> ; Woodstove I Grease Irap <br /> � Ductin Rootdrains <br /> j Other I Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM i Other: <br /> � Num6er of Heads I Other: <br /> I hereby certAy Ihat I heve reatl antl examined t�is applicetion ond know the sama to ba Irue and correct.All provisions ol lawa anC ortlinances goveming this rypa ol work wul ee compLeO <br /> �,c'h nite�her specdied herein or nol.7110 Branting ol a pertnit aces nol presume lo yiva aulnority U violate Ur Cancel t�e provision ol any oitler state or loCal law regulatinp consW ction <br /> Thm 1 am au�honzeE Oy t�e owne�ol l�ie pmperty ta peAorm t�a work lo�whictl appiicalion is matle ond I wmply wf.n tha State Conhectom Law 18 27 RCW an0 296200A WAC. �I <br /> • t � <br /> ����� �r. �l�'�. �i� �:,.��� > <br /> wnodAulhorimd Agent Signalurc I%ate (Revised 3?073) <br />