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PERMIT APPLICATION <br /> BUILDING/MECHANICALIPLUMBING/SIGNISPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 96201 425-257-8810 FAX 425-257-8857 www.everetlwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITEADDRESS: PROPERNTA%p T�O _/ti <br /> � „J e � V <br /> LEGAL for new wnstruction: Short Plallsubdivision Lot No._ (allach wpy ol long legal descnption) <br /> OWNER Q' \�e ,2 . ��.4�� Phone�E�mail � . ;.L --35%U va-'�. �� �� '- v_>�l a.\.wcr. <br /> Address �- ,y", eRy k Z \ CitylStalelZip _v2�zC� � <br /> APPLICANT:�.Ovmer _OvmefsAgent _Contracmr Contractor'sAgent _TenaNw�aP�o�.ne,k��roru��m�mme�ermao.oamc..:c�1 <br /> CONTRACTOR � p -� ,cc, - „i C L 8 I Lic.# COE Bus.Lic.# <br /> Atltlress PhonelEmail <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Jo.��,�e C.:,i�-,>m,��., <br /> PhonelE-mali �Ulu� -��v� <br /> BUILDING PERMIT APPLICATION CONrw4cT PRICE oF WORK_� �k <br /> HEAT SOURCE: <br /> Existing Use of Building <br /> Proposed Use of 8uilding Gas_ Eiectnc_ Oiher_ <br /> Building type: �,Single Family _Duplex_Townhouse _Mulli-Famity _..,Commercial <br /> Type of pro'ect: _New Addition _Remodel _Repair_T.I. Sign Sprinkler_Demolition_Chan e of Use <br /> DESCRIPTION OF WORK(addilional space pmvided on the back): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> TypeofProJecl: _New_Addn _Alteralfon_ftepalr TypeofPro)ect: _New_Atldn _Alteration_Repalr <br /> Show Num6cr(q)ol/lxfures Show Number(#)ol/Ixfures <br /> A/C-air handling units Toilet <br /> Forced air systems Balhtub <br /> Gas pipin Lavalo (wash basin) <br /> Waler heater Shower <br /> Gas fireplace Kitchen sink&disposal <br /> Gas range Dishwasher <br /> Clothes dryer Cblhes washer <br /> Range hood Waler heater <br /> Exhaust fan Sink(service/barlmop/etc.) <br /> Heat pump Backflow prevenler <br /> Unit heater Urinal <br /> Boiler Drinkin Founlain <br /> Refrigeration Floor drain <br /> Woodslove Grease lrep <br /> � Ductin Roof drains <br /> � Other Medical Gas <br /> SPRINKLER I SUPPRESSION SYSTEM Other: <br /> Number of Heads Other: <br /> I hereby cenrty IIia1 I nove rcaa uotl ezamined I�is npplicalion and know lho samo to ba iruo entl cortect.NI pmvuions of law�end oNmancee govemh8�����Y7a ol work nil be complietl <br /> with whelhet speciletl hereln or nol T�e grantinp cl a Pe�il tloas ml presumo lo gHo ouNony lo Nalale or cancel lne pmvisbn ot eny at�er slele or Ixal law rcgulatng consimction <br /> _7hPt I om Aulhotlzetl�y t�o own^r ol IMe D�operry lo pedorm I�a wod lor which applkalion 0 made end I compN w��Ne Slele ControGon Law 1827 ftCW anE Y96200A WAC. <br /> "__.__— �____.. <br /> � Date (Revised W2^121 <br /> � OwnedAuthonzed Agenl Signature <br />