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� � <br /> PERMIT APPLICATION <br /> BUILDING/MECHANICALIPLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 96201 425-257-8810 FAX 425-257-8857 v✓ww.everettwa.org <br /> 1 ` a �l— I�/ <br /> SIT�ADDRESS� PROPERTYiAXp PE T — � � O <br /> pL <br /> LEGAL for neei conslruction: Short PlaVsu60ivision Lot No._ (allach copy ol long le9al descriplion) <br /> OWNER (,�L e Phone/E-mail <br /> Address � � (j�m C(� Cily/S�atelZip <br /> qpPLICANT:_Owner _Owner'sAgenl '�CONractor Conlraaor'sAgent _TenaN�m�sicro��a„��aa:rcico�semoommoo.��rneo.oM��maspac�l <br /> CONTRACTOR r'� State Lic.#/.JeCcC 0 S/n �$City Bus. Lia # <br /> Address S• p�/� S�. Phone�Emal <br /> TFNANT BUSINE55 NAME CONTACT FOR PERMIT <br /> Phone/E-mail <br /> BUILDItdG PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Bwiding Gas__ Eiectnc_ Oiher_ <br /> 8uilding lype: �Single Family _Duplex__Townhouse _Multi-Family _Commercial <br /> Type of projecl: New Addition Rzmodel _Repair_T.I _ _Sprinkler_Demolition_Change of Use <br /> DE CRIPTIONOFWORK(add�rionalspaceprovidedontheback): V , p ' ,,' �L / _ / / /� <br /> �2 —���e � � �„} Gt.���6� C� �e S f 9U�.�� � ;�����c _ <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Typo ol ProJecL _New_Addn _Alleralion_Repalr Typo of Project: _New_Addn _Alleralion Repair <br /> Show NumDer/u)ol lixlures Show A'umber/NJ ol lixiures <br /> A/C-air handiing units Toilel <br /> � Foroed air systems Bathtub <br /> Gas piping � Lavatory(wash basin) <br /> � W2ter healer � Shower <br /> Gas freplace Kilchen sink 8 disposal <br /> � Gas range Dishwasher <br /> � Clothes dryer p/ � Clothes washer <br /> Range hood Water healer <br /> Exhausl fan � Sink(service/badmop/e1cJ <br /> � Heat pump � Backflow prevenler <br /> � UNt heater I Urinal <br /> � Boiler Drinking Fountain <br /> I Refrigeration � Floordrain <br /> Woodstove � Grease Irap <br /> Ducting Roof diains <br /> � Other Medical Gas <br /> SPRINKLER I SUPPRESSION SYSTEM � Other: <br /> Number of Heads I Other: <br /> 1 hereEy cenify I�a�I have tead an0=xamineU i�is app5wtlon and know the same to 6e Ime antl coned.Aii pwvlsions of laws and orElnances 9ovemin9 I�is lype ol�vork�s�I 7e compRed <br /> wi�h wheiher speciLed herei r noL The granling ol a permtl tloes al presume l0 9iu.amhorily to violate or rancel I�e prov�sion al any emer slale o�lacal law regelaiinq constrt�aion <br /> Thal I am aul zeG Oy� nner of i � ly la pe orm t�e rk fof which appl:cali0n is maCe anOl comcly�vi'M1��e Slale CoNracto�s L:w iP 27 RCVJ anJ 296 2GOA IVf.0 <br /> w edAulhorized Anc ;lanaturo 0 Date // (ReviSedY20131 <br /> � _ <br />