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PERMIT APPLICATIdN <br /> SUILDINGIMECHANICALIPLUMBINGISIGN/SPRINKLERIDEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES (� �-a0"�� <br /> 3200 Cedar St., Everett,WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.or� <br /> APPLICATIONS AFE ACCEPTED FROM 8 AM TO 4 PM S ������� �� <br /> SITE ADDRF.SS_ 1, <br /> PROPERTYTA%# PERMI t! <br /> �.Y� �i� :_V�°ir^n� �Y<I lJ��. 1120 � ���) 2�5 .. <br /> LEGALfcrnewconstruc�ion: ShoCPlaVsubdivision <br /> Lot No._ (a!tac�copy of long legal description) <br /> O W N ER PhoneiE-mail <br /> Address City/Stale2ip <br /> APPLICANT:_Ovmer OvmefsAge��� �ConVacter ContractorsAgeN _TenantlT�+:c�=���-eaieve,oicons«mn:.�otio�.mmioe��o�..+Nesoa=e� <br /> CONTRACTOR �T E� � ��' 1_��-'���' r'�- L 8 I Lic.0'- �C7(�t���l�{<`� 1�n1 COE Bus.Lia:c1,12� <br /> Fddress � u 'Y�J R�l� ,iPl�in ry �1p.�,� Phone.'Em2ii <br /> 2h1 a � 1_ ''IC'Y' <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT���.-t�'-+����t ��i- <br /> V �� ,.� c;..' r��._t�t� 3in h�-i.�-7 � - � 3�/3� F <• ,� r.?c�-t� . �c��:� <br /> rl�- �-_.t� V�•��� � � PhonelE-mail LPc�.r � " `Q-- � 1 <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK !h /�'-`U «'> <br /> HEAT SOURCE: <br /> Ezisting Use of Building <br /> Gas Eleclr,c_ Other <br /> Proposed Use of Building -- <br /> 8uilding type: Single Family _Duplex_Townhouse _Multi-Family �Commercial <br /> Tyoe of projecl New _Addilion Remodel Repair T.I. Sign Sprinkler Demolilion Change of Use <br /> DESCRIPTION OF W ORK(additional space provided on the back): <br /> � ��11 1'':', �'�(�,�� �'i�'� 11 <br /> MFCHANICAL PERMIT APPLICATION PLUMBIiYG PERMIT APPLICATION <br /> T;peolProJecL• _New_Addn _Alteralion_,Repalr TypeofProfecL• ShowNumber(#)oftixtores1fon_Repair <br /> Show NumGer(p)a���x�mes Toilet <br /> NC-air handling units Bathtub <br /> Forced air systems <br /> Gas piping Lavatory(w-.'.h basin) <br /> Water heater Shower <br /> Gas freplace Kitchen sink&disposal <br />� � Gas range Dishe+asher <br /> Clothes washer <br /> Clothes dryer \Nater heater <br /> � '- Range hood <br /> � `- Exhausl fan Sink(servicelbar/mopletcJ <br /> '- Heat pump Back9ow preventer <br /> i Urinal <br /> -- Unit healer <br /> - -- Boiler Drinking Founlain <br /> � -- Retrigeration Floor drain <br /> W oodslove Grease trap <br /> Roof drains <br /> Ducting MeC��cal Gas <br /> Oth.er <br /> SPRINKLER 1 SUPPRESSION SYSTEM I Other: <br /> I Number of Heads � Other: <br /> I ncreby ceMy lhat I have read entl eramined Nis appliwhon antl knoh t�e sartk�a he We arW cortect A�provisions c:aws enC orCinancc=poeeming this rype ofwork niA be compl�etl <br /> w�m v.hether specifietl herain ar not The granUn9 0l a permA tloes not Fresum[to gNu eullionry lo vblaln or cancei Me provision of any athar state or bcal Ww regulaun9 mnswctbn <br /> T�at I e uthotlzed by Ne ovmer�lhis properry lo pedorm ttie woM1 lor which 6apikiUon is maae and 1 wmply wM the State Cenlractors Law 1827 RGW antl 29fi.T00A WAC. <br /> ,\' _ , `` 1 � � II I I <br /> :\.1.�� '1��—', (RevisedG2012J l <br /> ner uthodzed Agent Sig atura �"�e / L <br />