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PERMIT APPLICATI�N <br /> BUILDINGIMECHANICALIPLUMBINGISIGNISPRIfdKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedef St., Everett,A PL CAT�IONS ARE ACCEPa ED FROM 8 AM TO 4 PM57 �'everetiwa�`g31`, <br /> PROPERTY TAX It PERMIT A <br /> SITE AUDRESS: . `,{( e � — <br /> ' �2 l <br /> lOU. tJ � <br /> LEGAL for new consWcfion: Short PlaVsubdrvision Lot No._ (attach coPY of long lega!dz�cnp6on) <br /> .Alc: <br /> . i � PhonelE-mail ;,�� .. .FS 3 ' .�"�; $ ; . . , ' �r C�rf�r" <br /> OWNER {'LFI��- A�� /Y-� - <br /> /Z �1 _3/ c�ryiscaie�r,v EU='Lb r` A `i'3_2D - <br /> AdtlreSs (�X'� a�� <br /> APPUCANT:_�Owner ._Ovmer'sAgent _Contractor _ConvactorsAgent _7enant�m�no��abnna���nvwnu+eow+m'°°°"°^'"°'°°c�°� <br /> `� L&I Lic.# COE Bus.Lic.# <br /> CONTRACTOR <br /> Phone/Email <br /> Address CONTACT FOR PERMIT <br /> TENANT BUSINESS NAME <br /> PhonelE-mail <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> HEAT SOURCF: <br /> Existing Use of Building <br /> Gas_ Eiectnc_ Other_ <br /> Proposed Use of Building <br /> Buildingrype: _SingleFamily _Duplex,�Townhouse �ulti-Family _Commerciai <br /> T pe of pro ect: New Addition Remodel Repair T.I. Si n Sprinkler_Demolition Chan e of Use <br /> DESCRIPTIONOFWORK(add�tiona�spacepro�idedontheoack): �c� �M 5/NG�GE �1�'ii�� ��4At; , <br /> ¢Z�pcacr �.��sr,u� C��i•s c��a,�:z b4� <br /> � -rp��� �,�t�� <br /> MECFiANICAL PERMIT APPLICATION <br /> PLUMBING PERMIT APPLICATION <br /> 'type of Projecl: _New_Adtln _.Alteralion l�Repair Type o(Project: _New_Addn _Altaralion_RePair <br /> Show Number(N)ol fixtums <br /> Show NumDcr(p)ollixtums � Toilet <br /> � A/C-airhandlin uniLs . Bathtub <br /> Forced air s stems Lavatory(wash basin) <br /> Gas pipin . Shower <br /> � Water heater Kitchen sinY,8 disposal <br /> � Gas fue lace Dishwasher <br />,.-., Gas ran e � Clothes washer <br /> � Clothes d er Water healer <br /> � Ran e hood Sink(servicelbadmop/e�c.) <br /> [xhausl fan Backfow preventer <br /> i tleat pump Urinal <br /> -i Unit heater Orinkin Fountain <br /> Boiler . Floordrein <br /> Reiri eralion � Grease Uap <br />�'� Wecistove Roof drains <br /> I �udio Medical Gas <br /> Olher <br /> '�� SPRINKLER/ SWPPRESSION SYSTEM Other. <br /> -�., Other. <br /> Number of Heads <br /> I�ercEy certilY Ihal I�ave roaE an�eramiied Il�is aDPfiwtbn anG Mnow I�e sama 10 bo truo and mrtea.A1 Drovisbns ol Ww's and oNinances goveming Ihis rype ol wn�k wil be compiad <br />!-._ mlhwheNerspetlfieEheminornoLThop�'a�i�9olape�mitEoesnotpresumalPPNeautnorirymvulaleorv°�nNeSW�eCn'Iracor.LaH1IP27HCtiJ,n42�62f10AWACceon <br />'�9��'�� Tiiat I nm a///u���t�onxeU�y Iho ownerol�his pNpeM1y to pertorm Uie ik Iorw�ich a icatbn�s maEe nnd 1 com ry <br /> : / � i <br /> i <br /> � I <br /> 1� .r �� i.L� <br /> ' / 3r i3 <br /> � �' � Date (Re�isedW20f2) <br /> fi;�:1�-� � O crlA thorizod Agen[Signature <br />����: ..iM��\ <br /> .��, <br /> .. _ � Y <br />( �. v � .... � u:. . ..e .n .G <br /> t`. � f � <br />�_ �� <br />