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PERMIT D�i�LICATiO�N <br /> BUILDING/MECHANICALIPLUIVIBING/SIGN/SPRINKLERIDEMOL1710N <br /> CITY OF EVFRETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 4�5-257-8810 FAX 425-257-8857 vnr✓,,v.everett�va.org <br /> SITE ADDRE55: �PROPEHN TA7(N P,�IRMI��'„�' <br /> I I I Lvn(�-�� �11Q. f� - <br /> LEGAL lor new mns�ructiort Short PlaVsublrvai�n Lot No .Ytach copY'of long legel Ces:,nption) <br /> owra<_R To� F.`� �none E-man Q JT�� 7ti 2 7 <br /> AdCress CrtylState2ip <br /> APPLICANT:_Owner __O�mefsAyem _Ccrtraacr _CcmratlofsAgeni _TenaMt��.t.R,��o,,e-.��r«-:�•-ir�m.inoc.,.K�i>eo..o«:.,¢oso�co� <br /> CONTRACTOR /`7oC � ���vu��'�—� StateLic �Y� �P .k�� r QryBw. Lic.#OS 7�� <br /> Atldress +�fS I S �-{(�� — .�..�..�:c� f'Z�U PhonelEmail y2rj 7�U �7 G V <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Phone�E-mail <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of Building _ HEAT SOURCB�. <br /> Proposed Use o(Building Gas Eiectric Other <br /> Building type: _Singte Family _Duplex_Townhouse _Multi-Famdy _Commercial <br /> T e of ro-ect� New Addition Remodei Repair T I. Si n S rinkler Demolition Chanae of Usa <br /> DESCRIFTION O,,Fl WORK�addf�ona�spacevrovidedon�he back)' <br /> �„t�z.���Of=(uu� CJ-c.«/� r1. �=tw✓ �c.�..� P��,�v ir si�n � �-� c�.Q <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APF�LICATION <br /> 7ypeof Project _New_Addn _Alteration_Repair TypeolProjecC _New_Addn _Alleralion_Repair <br /> Show Number(#)01 frxtures Show Number # ol fiaNres <br /> AIC—air handlin unils Todet <br /> Forced air s stems Bathtub <br /> Gas i in Lavato wash basin) <br /> Water heater Shower <br /> Gas fre lace Kltchen sink&dis osal <br /> Gas ran c Dish�vasher <br /> Clolhes d er Clothes washer <br /> Ran e hootl Waler heater <br /> Exhausl fan Sink servicelbadmo /elc. <br /> Heal um Backtlow reventer <br /> Unit heater � Urinal <br /> 8oiler Drinkin Founlain <br /> Refn eralion Floor dram <br /> Woodslove Grease tra <br /> Ductin Roof drains <br /> Ot�er Medical Gas <br /> SPRINKLER I SUPPRESSION 5YSTEM other <br /> Number o(Heads Olher: <br /> I�erc�y ceNry I�a1 I nove maa anE cramine0��is applictlion and Vnow Ue same Io Oe we an0 wrtecL All pmvisions ol laxs and ore nances govemmg Nis type ol worA wiA Oc wmpl <br /> vnln n�elher spttifiea nemin or no1.The eranlinq ol a pe�mtl does nol presume to give aulnoitly lo vblale or wncei Nu piovision ol any olper slate or lowl Ww m9ulaGng canslructian <br /> That I am auNonzeO Cy Nc owncr al N�s D�Daty to pertortn Nc work forwllaA�aDPliwuon is rt�a�c anE I comply�vN tlle SL��e ComiaGoro Law 18.27 RCW and 298100A WAC. <br /> ✓� ��-- u— —isr <br /> OwnedAulhorizetl Agenl SignaWre Da�c (Revised 9RO1d1 <br />