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P�RMIT APPLICATI(��1 <br /> BUiLDINGIMECFiANICAL/PL'JMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Evereti, WA 98201 425-257-88�0 FAX 425-257-8857 www.evereltwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 6 AM TO 4 PM Q- 1�— �Z <br /> SITEADDRESS: PROPERTYTA�(# QOyOIZO3 PERMITD# _ <br /> � � ��3 wo� i �,�. <br /> LEGAL lor new conslruction: ShoA PlaVsuhdivision �f �+5�o I b n 18�I Lot No.� (attach copy of long leyal descriplion) <br /> OWNER {-4UUC�� Q�S� ��S Phone/E-mail �25-29��ZW29 ° ��l h44Ck�7r��PrS,�rr <br /> na�«55 3 2 Z $ 7`�1' l.0 N E Ci�ylSlalelZip !Y�C�f Su i I�e U,KI� Q�d�� O <br /> .4PPLICANT: Owner Owner'sAgenl K Contractor Coniractor'sAgenl _TenaNtm�:ip�o»�eaionoroi��:��nrom�r.�o�.,rer:ocawcr����sasc3=�� <br /> CONTRACTOR I�`�U�-� �J�b'T1� � '��S L&I lic.#H����k U�$OI Z dZ COE Bus. Lic.# <br /> AdJress ,,,)-l�L � �+��v� vl� r w1lle L� � PhenelEmail qZs•ZqV"Z'i Z / <br /> CONTACT FOR PERMIT <br /> TENANT BUSINESS NAME ,��1 ���,GC� �ZS Z�d- Z�I�- <br /> PhonelE-mail 1[.'L\ � �\UC�C�'J������5•�U� <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> HEATSOURCE: <br /> Existing Use of Building < <br /> Proposed Use of Building J F�- Gas� Elactnc_ Other._ <br /> Building type: �Single Family _,Duplex_Townhouse _Multi-Family _Comrnercial <br /> Type of project X New _Addition _Remodel _Repair_T.I._Sign_Sprinkler_Demolilion_Change of U�e <br /> DESCRIPTIONOFWORK(additionalspacepmvidedonmeback): y-h e I <br /> N�� SF(z ���-ti-ti. c�i-tache� 2 cur yu � <br /> � <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APP6ICATION <br /> Type of ProJect: �New_Addn _Alteratlon_Ropalr Typa of Project: New_Adtln _Allerotion_Repair <br /> Show Numbcr(tt)o/lixtures Show Number(M)ol lixtures <br /> A/C-atr handling units '�� Toilel 6 <br /> � Forced air systems ; BalMub <br /> Gas piping i Lavatory(wash basin) I� I I <br /> 11 Waler heaier i Shower <br /> Gas freplace I Kitchen sin &disposal <br /> I � Gas range � Dishwasher <br /> � Clothes dryer I Clothes washer � <br /> Range hood � Water heater <br /> •4 Exhaust fan � Sink(s?rvice/badmop/elc.) <br /> Heat pump I Backflow prevenler <br /> � Unit heater Urinal <br /> � Boiler I Drinking Founlain <br /> � Refrigeration I Floor drain <br /> Woodstove I Grease trap <br /> � �ucting ! Roof drains <br /> � � Other j Medical Gas <br /> � SPRINKLER I SUPPRESSION SYSTEM Other: <br /> Number of Head: �i Other. <br /> I hereby ce�Ay t�al 1 have read and examined th�s application and know Iha same lo[e Imo and torrect.All p�ovisions ol laws and ordiwnces 9oveming Ihis Iype ol work will be comp!��e7 <br /> ;:I!h v:hel�er specifed herein or nol.The gmnlin9 0l a permlt tloes nol presuma lo give nuthority to v�olate cr cancel the pmvision ol any olher stata or lowl law re9ulaling consiruclion <br /> inat I em euthor¢etl Oy Ihe o•xner ol this m erty to peAortn�ha work forx�hlch aDDlication is matle and I comply wnh l�e Slate Contraclom La�v 1827 RCW antl 296200A WAC. t/ <br /> �1 '`'�(� y <br /> �� I `I�� �� (Revised6i:Ot2) <br /> OwnodA lho zed Agent SlgnaW Date <br /> T�. <br />