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PERMIT APPLICATION <br /> BUILDINGIMECHANICA!/PLUMBING/SIGNISPRIIVKLER/DEMOLITION <br /> C;TY dF EVERETT PERM�T SERVICES <br /> 3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-b357 www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM `—I I `� <br /> SITE ADDRESS: PROPFRTY TAX N PERMITO#Z / � <br /> �G�I ,S t-r��fr_ 1 �'�al /A +%�� � <br /> LEGAL for new consimclion: Shod Plat/subdivision Lot No._ (a�tach copy of long legal description) <br /> ��� <br /> OWNER V.�i{l�'�i _ PhonelE-mail <br /> Address City/StalelZip <br /> APPLICANT: Owner OwnersAgenl '�Contractor _Contracloi'sAgenl _TenanllR��:iv�orooaiereroiunsemtro„meo��er�om.o.kminos,a:o) <br /> CONTRACTOR f F� G-I-C L& I Lic.# ��S�L, 2°t m� COE Bus. Lic.# <br /> Address i�. i�C� �11i �ili;if�P (t IS. � �� �I� SC. Phone/Email S�'.%d��' 1��2�� / � � •C � QG C.OM <br /> TENANT BUSINESS NAME CON'i ACT FOR PERMIT ��p�J $fi�tfl <br /> , H LM �, � <br /> � ..�_� � ,A1 ���iil� }� ��rl: PhonelE-mau �1�:5-.3:�3�U�z�� <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORKs�C�""-' <br /> Existing Use of Building r�'��r�� HEAT SOURCE: <br /> Proposed Use of Building i c'���� Gas_ Electric_ Olher_ <br /> Building type: _Single Family _Duplex_Townhouse _Mulli-Family _Commercial <br /> Type of pro'ect: New _Addition _Remodel _Repair_T.I._Sign x Sprinkler,_Demolilion_Change of Use <br /> r, <br /> DESCRIPTION O�WORK(additional spacep ovided on the back : � �( A..1N�V�- i��Wt�L2a1(:� �'v't>tG? <br /> '��t�nC� .��,;(ir,�� �:��::.��CL�, A1.n13� �.cL C!v ,N'Co`�,.r,»� <Ce tL <br /> � 7 <br /> � 1 I� <br /> G+ h:,��CZOG� J Gli i� �0 <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Typoof ProJoct: _New_Addn _Alleration_Repair Typoof Projecl: _Now_Addn _Alteratlon_Ropair <br /> Show Number(#)o/lixtures Show Num6er(#)o/lixt�res <br /> AIC-air handling units � Toile� <br /> Forced air systems Bathtub <br /> Gas piping Lavatory(wash basin) <br /> � Water heater Shovrer <br /> Gas fireplace Kitchen sink&disposal <br /> � Gas ran e Dishwasher <br /> � Clolhes washer <br /> Clolhes dryer Waler healer <br /> � Range hood <br /> Exhausl fan Sink(service/badmop/elc.) <br /> He2t pump � Backflow preventer <br /> Unit heater Urinal <br /> 4 Boiler � Drinkin Founlain <br /> Refrigeration � Floordrain <br /> � Woodstove Grease lrap <br /> Ducling Roof drains <br /> � Other Medical Gas <br /> SPRINKLER I SUPPRESSlON SY�TEM Other: <br /> �umberofHeads Other. <br /> 1 hereby cenity that I have read and examined t�is appliwtion and Anmv t�e same lo ba Ime antl wrrecl.All provisians ol laws and ortlinances goveming this type of xork wJl be campl!ed <br /> r:en whel�er specilieG herein or no�.T�e 9 ranling ol a permit does nol presume to glve nul�ori�y to violam of cancel lhe pmvislon o f any ot�er sta�e or bcal iaw regulctinq censlmcuon <br /> Thot I am aul�otlzed 6y the owner ol t�is D�opetly lo pertortn�he vrork for which appllwtion Is matle anE I compty wAh the Stale Convactors L ew 1B 27 RC'NanC 2?6200A N'AC. <br /> ( �% ��r� }���i� ?�1i�13 � <br /> Owna AIDhorizod Agont 519nature Date (P,evised 6.2012) <br /> c i <br />