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• s <br /> PERMIT APPLICATION <br /> BUILDIf�GIMECHRNICALIPLUMBINGISIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Gverett, WA 98201 425-257-8810 FAX 425-257-8857 wvrw everefM�a,org <br /> SITE ADDRESS: �O� //�,f�� PROPERTV TAX p PERR IT xO � <br /> �'7�/ � <br /> LEGAL lor new con;lruCtion- Stion PldVsu�nrvis�on Lol No_ (alta.�9 ccpy of long legal descnpli9n) <br /> OWNER L CQ� PhoneiE�maJ <br /> rCd�ess `(/ ��v L Gf/ CilylSla;e/ZiP (G;(C �i � `y f� ` <br /> APPLICANT.: Or+ner Gwne�s:�genl Comraelor ConlraetersA9ent _Tenanii�.��.�:�o.�a��a�.s�::�.:u��:�-.irtc.�u+oc..�e���:c�„or„mr�;,�.�i <br /> CONTRACTOR Q uv IlC/' State Lic # City Bus. Lic # <br /> l�d�ress FhOne�cmail <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> PhonciEmad <br /> BlJILDING PERh�IT APPUCATION CONTRACTPRICE Of WORK �( ,{/ -OC � <br /> Ex�sung Use of�uddi�g HEAT SOURCE <br /> Proposed Use of Bwlding Gas_ Electnc_, CIY._r _ <br /> Bw�dmg type �Smyle Family _Dupl/Cx_Ta:+nhouse _tdW6-Family _Commercial <br /> Type of pre�ecf New Adddion i/ Remodel __Repair__T I. __S�gn __Spnnkler_ �emclihon_Change of Use <br /> D ESC R I PTIO N O F W O R K(aCditio�al space provitleu on fhe back{. <br /> ��f ���.P� �-�v �urhace� dv�er Hwt � <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERNiiT APPLICATION <br /> Type o!ProjucC _New_Addn _Alleration_Repair Type ol Project _New_AUtln _Ali�ration_Repair <br /> Show Numbcr(.H)ollirNres Show NumOcr(a)al/irfures <br /> 1 PJC—air handi�ng umts I Toilet <br /> Forced air systems Bathlub <br /> Gas piping Lavatory (wash basm) <br /> � Water hea�er Shower <br /> Gas fueplace � Kdchen suik&tl�sposal <br /> � Gas ian9e Disrnvasher <br /> � Clothes dryer � Ciothes washer <br /> Range hood � VJaler heater <br /> Exhaust(an Sink(serv�ce/badmopletc) <br /> Heal pump � �ack(low ptev2nter <br /> Und heatcr � Unnat <br /> � Boiler I Onnking Founlam <br /> � Refrigeralion � Floor drain <br /> Woodstove � Grease Irap <br /> Ducting I Roaf drains <br /> Other � Medical Gas <br /> SPRINKLER I SUPPRESSION SYSTEM I O�her <br /> Number of Heads i O�her. <br /> I I�cieby ceMy I�dl I�ove reatl ana exam�netl I�is apP^���'�on a��ti�nw I�e same lo be ime antl W rreU All promvons cl lax�s ond ortl:nan�es yovemmy t�is lype ol�aoik v."�be cemn'.^^ <br /> v.tlnrvnclner=FenfieGncicinornot TnegiaNingolupermilCoesnolFresumetogn'eaWnorilyloviolateorwnccllnep�owsicnolanyclnerst�IeorloWllawreaulatmg�cn;lm:;w^ <br /> i•�ai i am auinn�•c6Lya oFRE1Z'4tlr�pe�ty lo DcAortn Ine work Icr wn�:c�apni��wlion is maae an01 comDly wiln Ine 51a1e CONradors Ww 18 17 PC W an0 29G 20�A V:�.+C <br /> ;— <br /> ��/rs <br /> p::��,_,�rAi�IhorizeAAgen� Siqnatum D�Ie .'..__.. _,'�� <br />