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� � <br /> PERMIT APPLICATION <br /> BUILDINGIMECHANICAL/PLUMBINGISIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 982Q1 425-257-8810 FAX 425-257-8857 www.everettwa org � <br /> `) <br /> SITEADDRESS: PROPERTVTAxN PERMIT D � ' <br /> D o,+,bq� �e . <br /> LEGAL tor new tonstruclian� Shon PlaVsubtlivlsion Lot No. (altach copy al long legal tlescription) <br /> OWNER � � PhonelE�maJ �LZS'�cS2' S <br /> Address j� [,_, �y V�• Ciry/Slale2ip �u<v�-f{- (,�J �g�0 <br /> APPLICANT: Owner _OwneYsAgent �Goniractor _Conlrado'sAgenl _Tenanllmu.�c�o�+�eeaicnerciccnsemho.rinoo»ner:oao�.rkmmosv�=e� <br /> CONTRACTOR o r� w la u �.. r�anl;n �i,c S�ate �ic. tt AFFUR HI'`�l0 K - Ciry sus. Lic. x <br /> address,3s/S q�(�D�. SE. . f��<hf w/4 g2S5J PnoneiEmaA `/25�33�'I ^SYO�J <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> PhonelEmail <br /> BUILDINGPERMITAPPLICATIQN CONrRACTPRIceoFwoRK SDod - <br /> Existing Use of Building�c5ic�c..c.c HEAT SOURCE. <br /> Proposed Use of Building Gas X Eler.inc__ Olher__ <br /> Budtlinq type� �,Single Family _Dupiex_Townhouse _Mutli-�am�ly _Commercial <br /> Type of projecC New Addilion Remodel _Repair_TJ._Sign_Sprinkler_Demoli6on_Change of Use <br /> DESC RI PTI ON OF W OR K(additional space Frovided cn the baca): <br /> I`�- IRGL InL �(/✓ y�qLC K✓ILC VG/OV�G -1 �`G NLW �✓G1WON� <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT AP'PLICATION <br /> Typo ol ProjecC _New_Addn X Alluration_Repalr Typo of Pro�eCh _New_Atltln _Alteralion_Repair <br /> Show Numbcr(N)ol lixfums Show Num6cr(p)ol lixtures <br /> A/C—air handling units Toilet <br /> Forced air systems Bathtub <br /> Gas piping Lavatory (wash basm) <br /> Water heater i Shower <br /> Gas freplace � Kilchen sink&disposal <br /> Gas range Dishwasher <br /> I Clolhes dryer I Ciothes washer <br /> Water heater <br /> _ Range hood I Sink (servicelbar/mop/etc) <br /> ExhduSl fdtl <br /> � Heal pump � �ackflow preventer <br /> Unn hea�er � Urinal <br /> � Boiler � Drinkiny Fountain <br /> I Rehigeralion � Ftoor drain <br /> Woodstove I Grease trep <br /> Duciing Roof drains � <br /> � Other Ntedical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM I Olher <br /> Number of Heads I Other <br /> I�ereEy ceNly Ihat I�ave reatl and eaamined Ihis app5calion anE know t�e same�o Ee Irve ana corretl.All pmvlsions ol laws and or0inances gow rning Ihis type ol work wCi Ue compl�.e� <br /> weh whet�er spenfe0 Pereln or ncl The grani�ng of a permii Gocs nol Dresume�o give aWnorny io vioia�e or cancel tne provrsicn ol any o:ner stato�r tocal iaw regWa��ng mnsw:i�on <br /> Thal I am aulnorizeE�V�ne owner ai I�iS pmpeny lo pedortn Ihe work lor whicb appl�calion is ma0e an0 i comply wA0111e Slale COnlmclors Law 1tl 27 RCW arA 296200A V;FC <br /> CA�,��> � .d�,./� /-8-2�/ Y <br /> OwnedAuthorizetl Agent Sig ure Date �Revise0 3/2013) <br />