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PERMIT APPLICATIOf�! <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT' PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 425-257-8810 F(UC 425-257-8857 www.everettwa.org <br /> APPLICATIONS ARE ACCEPTEO FROM 8 AM TO 4 PM <br /> SITE ADDRESS: � �' PROPERNTA%N P M T <br /> /" /D ri (�� . � /Z� / 2 O '�'o2v��/Oz IO-c���- <br /> LEGAL lor new wnsimclion: Short PlaVsubtlivision Lot No._ (at�ach copy ol long legal tlescnption) <br /> OWNER � (,� e 0 — � P�onelE�mail <br /> Atldress � /U /�J /� . ��` City/Stalel2iP — L — / �'—� � O <br /> P.PPLICANT:_Owner Owner'sAgent Commdor �CONraclor'sAgent Tenante��+�c�o:maa�r.o�oim,sennomnowme�i�o�Hoa�:,.5asa.,=��� <br /> CONTR4CTOR /� (J � G/ L&I Lic.# �I`"SJ l�LPJ[z,b COE Bus.Lic.# <br /> AtlOress �U�l� � (� � l' � � L�C�.. �-� 'yJ L� �honelEmad �., C��— U— �— <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> (� L�jr� � ,,, �2� Phone/E�mail <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Exlsting Use of Building HEAT SOURCE: <br /> PrapoSed Use of�uiltling Gas_ Eledric_ Ot�er_ <br /> Building�ype: _Single Family _Duplex_Townhouse _A7ulti-Family _Commercial <br /> Type of projecC New _Addition _Remodel _Repair___T.L_Sign_Sprinkler_�emolition_Change of Use <br /> DESCRIPTION OF WORK(.d:���iona�space p�oa�deeon me oace)�. � jy ,� � �� � <br /> j G� �� <br /> T /: <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of ProJect: _New_Addn _A��eration_Repair Type of ProjecC _New_Addn _Alleration_Repai� <br /> Slww Num6er(AJ ol lixfures Show Number(�J ol lixfums <br /> NC—air handling units � � Toilet <br /> Forced air sys�ems BathWb <br /> Gas piping � � Lavatory(wash basin) <br /> � Water heater I Shower <br /> Gas fireplace I Kitchen sink&disposal <br /> � Gas range Dishwasher <br /> � Cbthes dryer I Clo�hes washer <br /> Range hood i Water heater <br /> Exhauslfan I Sink(servicelbarimop/etc.) <br /> Heat pump I Back(low preventer <br /> Unit healer I Urinal <br /> Boiler J I Drinking Fountain <br /> ;,efrigeralion I Fbordrain <br /> Woodstove Grease frap <br /> � Dccting I Roof drains <br /> i Other � Medical Gas . <br /> SPRINKLER / SUPPRESSION SYSTEM other: D / � <br /> � Number oF bleads O�her. <br /> II r�.srel>y cenify Ihal l have:caJ anu exaimnc�inls appHcaUon untl know�ho samo lo Co Wo anG Wrtect.All prmisiom ol laws antl ardinances goveming I�is ry0o olrmrk�all be<cmpf.ed <br /> c:^_p whe�he�spe[ifie0 nercin of nol.T�o 9mnling ol n pemul does no�pmsome�a O�e oul�only la vioWlo ot wncel Ina pmvision cl any e�lher stal:or Iccal Li'n regvla0n�consin¢.ion <br /> I lcn I nm auNoiized uy��a owner ol this pmperty to petlortn lho work br whk�apPfwotion la meCo anG I compy wA�I�o Stnte Crnlra:'�vs Law 18 P RCP:.mtl Pf��.00A l4FS. <br /> � , O 3 / <br /> � <br /> /� �� ,�.i�'`�i�� � -� �- <br /> Ovincrl�uthoriicd A9ont Sl�nalurc ' Da:o (R�^rsed f✓ZOi2) <br />