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PERMIT APPLICATION <br /> BUILDINGIMECHANICAL/PLUMBINGISIGNlSPRINKLERlDEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Fverett, WA 98201 425-257-R810 FAX 425-257-8857 wvrw.everettwa.org <br /> 3—{I-1 <br /> SITE ADDRESS: 1 �O� �; . 1;1� VROPERTY TN(p . P MIT K <br /> � W l � 5 <br /> LEGAL lor nr.w wnsirucuon. Short Plalisuhtlivision Lal No_ (aflach copy ol lang Icgal descriptron) <br /> OWNER e,s � Ir PhoneiE-maJ � S'p�5�—��p <br /> Address 4a Sa� �� ��. ��tY,s�.,,�,1�, e 8 <br /> APPUCANT: _Owner Ow'neisAgen� Coniraclor ConlraClo�sAgMl �7enan16��.+ip�:v.rn�iouc�cicc��.�ertvcr�auc+.x�'oao.cnmme+�a:e� <br /> CONTRACTOR en w Gll State Lic. # City Bus Lic # <br /> ACtlress Pnone:Emad <br /> TENANj BUSI�ShNAM1A�.�� CONTACT FOR PERMIT 1L ��� S/ `W O O� <br /> S�K-ei� �p ' 1 'I dheicG' i <br /> � <br /> PhonclE-mail M� — y� �ro Q�� <br /> BUILOING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> E.�sting Use ol Bwid�ng ��('�..� HEAT SOURCE <br /> Proposed Use of Bwlo�ng_-�'�'I� S�� 'f ���1� � C, 01V11Y1Q��� Gas__ [iectnc_ Otter _ <br /> DuJding lype�. _Single Famity _Duptex_Townhouse _MWtrF�dy �j Commercial <br /> Tvpe cf pro�ect Ncer Atlditon Remotlel Repair_T I Sign___Spnnkler___ Demoidion_Change o(Use <br /> DESCRIPTION OF WORK !;dnrr�:v:e:,cc e�c+,:eden rr.e oacui <br /> N'la�C.t� b0.cl� c��i� c� I�o�.� `�+ �°�r e�GlnC2., nE�1 S}U.irS <br /> �„�.� �oo,��,,r.dt ne�.� ex-lelc,t`c�ru.r�.Q11 . <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New_AEdn _Alteration_Ropair Typo ol Project; _New_AdO� _Alteratlon_Ropair <br /> Show Numba(M)o/liihves Show Numbc�(rJ olOxtmes <br /> I NC—airhantlhngun��s fodcl <br /> � Forced air systems Oathtub <br /> Gas pipin9 I Lavrdory(e:ash basin) <br /> i 1Nater healer i Sho�.ver <br /> � Gas 6icplacc � Kitchen sink 3 disposal <br /> ; Gas rnnge DisR;�ashei <br /> I Clothes tlryer j Cbtnes tvasher <br /> Ronge hood � Wakr heater <br /> [ahaust fan Sinh(servicelhadmop/elc) <br /> Heat pump I 6ackflo�v prevenler <br /> Unit heater Unnal <br /> 13oiter 1 Drinkma Founlain <br /> � Refnyeral�on � Flacr diam <br /> Woodslove I Grease Irap <br /> Ducling � Rool drains <br /> OUier i Medical Gas <br /> SPRINKLER I SUPPRESSION SYSTEM othe• <br /> � Number of Heads � Olher. <br /> I�eieEy ceniy inat I have iea0 onE a.am;�ed:�is aGPl::abon a�d hnow I�e same la�e vue and couect All pm�ns�ons ol lans anG ohinances governing ihn rypu ol work w91 be e�mpt�ea <br /> wrn xne;per speuliea�ere:n o'noi P e 9rantinq al a permA Ooes not presume io Gne am�oniy to nelate cr wncelln^provision ol an�o�ner slale or lowl Iaw�e3ulalmg conettuction <br /> Inat i am aut�on:ce Ey the o.. !�ol t�o pra0erty'o peAorm Ine werk for wnm�apphwtion is ma0c ana l<omply wi��I�e Slate CeNra:fors Law 1B 77 RCVlanO Z9G 2COA N'nC <br /> -,�/4���� % a s `Iz <br /> w9 nor/Authori Agent Signature Uate (Rc�ased 3?01J) <br />