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� � <br /> PE�RMIT APPLICATION <br /> BUILDING/MECHA.NICAL/PLUMBING/SIGNlSPRINKLERIDEMOLITION <br /> CITY OF EVERETT PER�diT SERVICES <br /> 3200 Cedar St., Eve ett, WA 98201 425-257-8810 FNX 425-257-8857 www.everettwa.org <br /> —30—��/ <br /> SITEA9DgE�5: G��� PROPERNTA%q PER�AIT# <br /> �l �— �3 <br /> LEGAL lor new constr�clion: Short PlaVsuhdivision_ lot Plo. (atla[h copy of long legal tlescnplion) <br /> OWNER �G.✓/N ^��Df�/��_ PhoneiE�mail �I � - ��p�-�' - �C� <br /> Adtlress �S Z,3 �/n�/�/e.� CitylState2ip `V,��� • �zQ,/ <br /> APPLICANT:�Owner _Owner'sAgent _Cortractor _ConlractorsAgenl _7enanl�m,sio�o+�.:oa��ne•mur;c,nrorinoo,�c:�aeoworw��masp��o� <br /> CONTRACTOR State lic. # City Bus. Lic. # <br /> i Ftltlress PhonelEmaJ <br /> TENANT BUSINESS NAM CONTACT FOR PERMIT <br /> v� �Wne� <br /> PnoneiE-mail <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK N fI <br /> Existing Use o(Building liFie _ HEAT SOURCE� <br /> Proposed Use of 0�iding Gas__ Eiec�nc_ Other_ <br /> BuJd�ng type. _j Smgle Famdy _Duplez�Townhouse _MWh-Famity _Commercial <br /> Type of projecl _ New _AddAion _Remodel __Repair_T.I._Sign_ Sprinkler_Demolition Change of Use <br /> DESC RIPTION OF WORK(aad�r�onai space F�o���'ed cn rhe back) <br /> yOl 7�/8 Ol/�'�dU�/L) �,�y�G I <br /> MECHANICAL PERMIT APPLICATION P�UMBING PERMIT APPLICATION <br /> Type ol ProJacl: _New Atldn Alteralion_Repair Type o1 ProJect: _New_Adtln _Alteratlon Repair <br /> Show Numbcr(a)ol lixNies Show Numbrr(a/o/lixNres <br /> A/C-air handlinq unds I -I ode� <br /> I Forced air systems Bathtub <br /> Gas pipmg Lavatory (wash basin) <br /> Water heater Shower <br /> Gas fireplace I Kitchen sink 8,disposal <br /> Gas range Dishwasher <br /> I Clolhes dryer � Clothes washer <br /> � Range hood <br /> I Water heater <br /> Exhausl lan � Sink (service�bar/mop/elc) <br /> � Heat pump <br /> � � � Unit heat2r I Backflow preventer <br /> I Unnal <br /> I �oiler Dr�nking Fountam <br /> i Refrigeration � Floor drain <br /> I Woodstove � Grease Irap <br /> Ducling � Roof drains <br /> � Other � Medical Gas <br /> SPRINKLER I SUPpRESS10N SYS7EM I O�her <br /> NumberofHeatls I Other <br /> I�ereEy ceCAy I�al I�ave rC30 an�eeBmineq��,appLWtion an0 knoH�ne same lo�e Irue.n���rrecl All provisions of iaws anU orE�nances goveming Inis lype ol worA vnil�e compLeC <br /> a•nM1 wnel�er specife0 nmem ar n�t T�o gr�nhng ol a pertnrt does not presume to grve aul�oniy lo violale or caocel��e provision ol any olher siale or laal law re9ulah ig[enslmq:on <br /> T�m I am authonxca by I�e or:ner ol l��s propeity lo petlorm Ine work lor w��rch app6cahon is ma0e antl I comply vut�Ihe Slate CaNraclon Law 18 77 RCW antl 796 200A WAC <br /> � ,.� y o�, <br /> er/Au� ' ed Ag Signaturc Dale (Rev�setl JR013) <br />