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* � <br /> �PERMIT APPLICATION <br /> BUILDINGIMECHANICAL/PLUMBINGISIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.ev�rettw3 r�U <br /> $ITE AODRESS:/ ��O LD ��('� � e PROPERN TAR p PE h7 T x ' <br /> LEGAL for new construction�. Short PlaUsubdivision Lot No. (attach copy ot long legal descnplion) <br /> OWNER �Li lZ G ( GG PhonelE-mail <br /> Anaress ,7j 3 (� LOa29 . Gl y' r'fV� Q Cityl51ate1Zip <br /> APPLICANT: Owner _Ovrner'sAgent �Contraclor CONracror'sAgent Tenant�m��siwohaeaiene�oice.�semirom��eo,��erioeowoM�.nxeser.e� <br /> CONTRACTOR p 1 � s A 'J S Stale Lic. # ,C1 ,LG � _���Y Bus. Lic # <br /> Atlticess Phone/Email <br /> TENANT BUSINE55 NAME CONTACT FOR PERMIT <br /> PhoneiE�mail a� <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of Buiiding �Q� _ HEAT SOURCE-. <br /> Proposed Use o(Building Gas _ Electric___ Other_ <br /> Building type�. �Single Family _Duplex_Townhouse _Multi-Family _Commercial <br /> Type of projecf. New Addition _Remodel _Repair_T.I. _Sign_Sprmkler_Demolilion__Change of Use <br /> DESCRIPTION OF WORK (addrriona�space provided on ihe back/� � Q_ v-�A .� I � / w�f„ _�...�i��, <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Typo of Projocl: _Now_Addn _Alteration_Repair Type of ProJect _New_Addn _Alte�ation�Repair <br /> ShoH�Numbrr(#1 0/lixlures Show Number(d1 0l lixtures <br /> A/C—air handling unils I Toilel <br /> � V Forced air systzms Bathtub <br /> — Gas piping Lavatory(wash basin) <br /> Water heater � Shower <br /> Gas freplace � Kilchen sink 8 disposal <br /> Gas range Dishwasher <br /> I Cbthes dryer I Clothes washer <br /> ( Range hood Water heater <br /> Exnaust(an Sink (servicelbadmopletc.) <br /> Heat pump � BackOow preventer <br /> Unitheater I Uiinal <br /> � �oller � Drinking Fountain <br /> Refrigeralion Flour tlram <br /> Woodstove � Grease lrap <br /> Duding � Roo(drains <br /> ( Other � Medical Gas <br /> SPRINKLER I SUPPRESSlON SYSTEM I Other <br /> Number of Heads � O�her: <br /> I Aereby certity ihai I have rcad anG e*amin=d Ihis app[calion and know Ihe same�o Oe lme anC corred.All provisions o�laws and o�0inan<es 9oveming I�is type ol vrork wdl�e wmplie0 <br /> v.�.m anether speu�ietl herein or nol.Tne granhng of a peRnA aoes not presume lo grve aWponty�o viola�e or wncel lbe provisian ot any olher stale or local law re9ulalln9 ronslruclian <br /> inat I am�mborize0 by Ihe o.mer ol ihis pmpetly�o peqo�m I�e wo�k lor w�ic�apPhcalmn is marle antl I comply wah��e State ConVaclors Law iB27 ftCW antl 296100A'A'�C \ I <br /> OwnedAu��A en�g�e Datc ;Fevised��'p1�� � <br />