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PERMIT APPLICATION <br /> BUILDING/MECHANICALlPLUMBfNGISIGN/SPRIfVKLERIDEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 v✓ww.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM a � o� —/ <br /> SITEADDRESS: i PROPEPNTAXp PERMIT# �. <br /> /�Q� � GVede$ al t1 �2� 0 00 i 3c :� - , <br /> IEGAL for new consirocuon Short Plal/subdrvis�on J�C S�t�Gi 1 I•U Lot No (attach copy o�long legal descnp�ion) <br /> OWNER G 6 d�ll!(�j PhonelE-maii yZJ �{53- 5 <br /> Acdress I ��2� �p� , �yQ Ciry/State2�p � �. w <br /> APPLICANT: Ovmer �Ovmer'sAgen; Con�racmr .ConiracrorsAgent Tenantim�siom.�aea�en=�oi�c�:e�.n,ommeo�enoa�..-,n��me,:.,-��� <br /> CONTRACTOR L.L� L 8 I Lic.#S�J TZ� IZK COE Bus. Lic. # <br /> Adtlress �13� ��'l�� {�.�. �� PhonelEmail �(�J"'/�I — ��L� <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> C�IDbaI �.�siVt.�_.SS SDlc�ov�S P�PE I, Tass�i _ ., x i 7 <br /> BUILDING QERMIT APPLICATION CONTRACT PRICE OF WORK CoS�G <br /> Existing Use of Dmlding�� HEAT SOURCE�. <br /> ProposedUseofBuilding 1'S �0{'�tC��{ G�UCA.'{'i�� cas_ eiectnc Otner_ <br /> Ouilding type�. _Singte Family _Duplez Townhouse _Multi-Family�Commercial <br /> Type of pro�ect New Addition _Remodel Repair T.I._Si n Sprinkler_Demolition_Chan e of Use <br /> DESCRIPTION OF WORK(additional space providetl on the bach): <br /> rli��o�, ii�l-e�io� ��7�alfliar�, i�c�c,� I�+-i�iov�S , c(aors a,ha� r�l��fc.s <br /> tlo ��(c��i ov c�a �-i` . <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type ot Project: _New_Atldn _Alteration Repair Type of Project: _New_Addn _Alteration_Repair <br /> Show Number(N1 0l lixtures I Show Number(#1 0l fixfures <br /> I A/C—air handlin units � Toilel ' <br /> �� Forced air s�stems ; � Bathtub <br /> ' Gas pipin - ' Laveto (wash basin) <br /> � Waterhealer� � Shower <br /> � Gas(ireplace Kdchen sink 8 disposal <br /> ' Gas ran e � Dishw2sher <br /> � � Clothes dryer Clothes washer <br /> � Range hood Waler heater <br /> I Exhausl fan Smk Iservicelharlmoplelc.) <br /> Heat pump Backflow preventer <br /> Umt heater Urinal <br /> Boiler Drinking Fountain <br /> � Refri eration Floor drain <br /> Woodstova Gease trap <br /> � Ductln / � ' Roof dralna <br /> Other � ' Medicai Gas <br /> SPRINKLER / SUPPRESSION SYSTEM Other <br /> � Number of Heads Other: <br /> Ihe�eGyceililyt�011liavereaHlin�ca-vminedl�isappliWiionUntlknowllms�nlelo�olmeandconect f.Ilprovisionsollmv5andor0innncesgovorNnplN5lypeolworkvnllCecompLeJ <br /> n�d0 whelher 5poci�ieJ he�en oi nol Ttro 9ranlmg oi a pennit does not presume lo grve autlion�y�o valale or cancel Ilie pronsion cl eny o��e�slale or local�aw repulahn9 roaSim�Cnn <br /> I na�I am aulhonzea�ti��e owner oI INs pmpetly to peNorm iho work/or whc�apphcalwn is metle ena l compry vni�Ne State Conlractors Larv 19 27 RCVI anC 296 300A V�AC <br /> . _� . � � <br /> iC� (_� ���� � � <br /> O wt/AithorizedA9entSignaWrc / i Date (RevisedP20tt1 <br /> '-� ��Z <br />