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� � <br /> PERMI i" ���PLICATfON <br /> BUILDINGlMECHANICALIPLUMBINGISIGNfSPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar SL, Everett, WA 98201 425-257-8"'0 FAX 425-257-8857 www.everettwa.org <br /> -as--►�t <br /> SITEADDRESS: ,) ZD / � �il PROPERTYTA%N PER�dIT# - <br /> L 7 Lo <br /> LEGAL for new conslrvcGon�. Short PlaVsuhdivision Lot No_ (allach copy of long legal tlescription) <br /> �" I�%/� /�- Y"lcAz...C�. <br /> OWNER U (,(_G� E�(Z.iQ /�eNt�.�,� Phone/E�mail 20 - 3 0 � "D e a <br /> Address Z`i o �4M $T P� � c��visiaierz�u EJ�t`�T ° Za <br /> Eu_.- A oD� <br /> APPLICANT:�Owner _Owner'sAgenl Coni ctor Conlr�ctor'sAgen enaMim�sic�o��e.oienermccr.scmo-er,moa.�=r.ocowoM�nmozc,:r1 <br /> CONTRACTOR � L � � u- cA-.J f�-` Slate Lic. # Gty Bus Lic.# <br /> ' � ov.�f.���_, p��onelEmail <br /> Address <br /> TENANT BUSINE55 N.4ME CONTACT FOR PERMIT <br /> Phone/E-mail <br /> BUILUING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Exis�ing Use of Bwlding � Si>' �7 sv� HEAT�OURCE. <br /> Pioposed Use of Building Ss4vK"� Gas_ Electnc_ Olher_ <br /> Bwlding type. ^Single Family �Duplex_Townhouse _Multi-Family _Commercial <br /> Type of prqecl. New _Addtlion _Remodel _Repair_TJ._Sign__Sprinkler__Demolition_Change of Use <br /> DESCRIPTION OF WORKlaeamonaispaceprovidedonthehack): <br /> CoM�$i^� c'`-. Z c,�A9E-�. g�ir-Jlc,.. .M�rLS� s 7'0 .1_- n�7L.`,Z. <br /> MECHANICAL PERMIT APPLICATION PLU�ABING PERMIT APPLICATION <br /> Typo ol Projoct: _New_Ad�n _Alleration_Repai� Type of ProJect: _New_Addn _Alleration_Repair <br /> Show Num6cr(H) ol lixfures Show Number(N)o(lizfures <br /> AIC-air handhng units � Toilet <br /> � Forced air systems , f3athtub <br /> Gas piping � Lavalory (wash basin) <br /> 'JVater healer I Shower <br /> Gas fireplace � Kdchen sink&disposal <br /> � Gasrangc Dishwasher <br /> I Clothes dryer � Clothes washer <br /> j Range hood i Waler healer <br /> Exhausi(an Sink (servicelbarlmop/etc � <br /> � Hcal pump � Dackflow prevenler <br /> - � Unil heater I Urinal <br /> � Boder 1 Dnnkmg Fountain <br /> � Refn9eration � Floor dram <br /> � Woodstove � Grr.ase trap <br /> Ducbng � Roof drains <br /> � Other � Medical Gas <br /> SPRlNKLER I SUPPRESSION SYSTEM I O�her �„�ir-,-�aL L�,JS— <br /> I NumberofHeads � Other. <br /> i nereby ren�ly Inat I�ave�e:tl and eRamine0 t�is app!�wtmn and know I�e same ro�e Irue anE correct.All provisions al law;nntl or0inances 9oveming Ihis IyDe ol work w�7 Ge comp�.ied <br /> wAn wheiher spN.ifed Oercm or not.T�e 9ranling ol a pertntl does not presume lo grve avlhCi�y 10 violale ar wncel l0e P�ovision ol any ol�er slale�r lowt Idw re9ulalin9 ron,IN:Lon <br /> Tnal I am aulnorveE Oy ihe owner ollnis propeny lo pertorm Ihe work lor w�ic�appllwlion is ma7e antl I comply wnn Ine Slate Co��retlon law 18 27 RCVr and 296.2�OA WAC <br /> �_ 0 " 7�G __ `( z� I <br /> O nerlAuthorized Agenl Signaluro � <br /> Date �Revised 3.4013) <br /> I <br />