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�ERMIT APPLICATIO� <br /> BUILDINGIMECHANICAL/PLUMBINGISIGNISPRINKLERIDEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES 9�/f`I y <br /> 3200 Cedar St., Everelt, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br /> OC1��g <br /> S�TEADDRESS: 1�j2-Z NPW�H��e � �����t/��ZU� PftOPERTVTAXN PERMITK <br /> LEGAL loi ne�v conslrutlion� Shotl PlaUsuOAivision Lol No._ (attach capy ol long legal descr�plron) <br /> OWNER �{1q uriu �u�C(S 7ZUh Phoncie�m,d��JZrj'�-5J� '23�U q�aamAriu22Z$�f�."` <br /> naa«ss �o7 �03'�� � SE GlylStatclL�p f�tvehF wA 982�� <br /> APPLICANT: )� Owner Gvmer'sA9ent Con�ractar Conhatlor'sAgent _Tenantfm:,sipm.�a+uipuo�o�c:o:enummmoc,-ner•aeowo+�,�ras;o:c� <br /> CONTRACTOR (,L 'T - State Lic # P�. O v City Bus. Lic. N S <br /> Adtlress p pZ�� .� ILUIV �N '1 nZ� PnonelEma�l NZ f' 7 S�- �S�L <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> ���'L P�2E2 <br /> Phonci6ma�i -��� - ��, <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK ° bu <br /> Ezisling Use of Building HEAT SOURCE <br /> Proposed Use of Bwid�ng Gas_ Eiead�__ omer_ <br /> Buildmg type� _Smgle Family _Duplea_Townhouse _MWti-Family �Commercial <br /> Type o(project. New Addition Remodel _Repair_T.I._Si9n_Spnnkler_Demoldion_Change of Use <br /> DESCRIPTION OF WORK�admnonai spac�frovided on Ihc bacti) <br /> �/��l �O/Uz./�S�£ �A� <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type ol Projecl: _New_Addn _Alteration_Repair Typu ol Project: _New_Adtln _Alteratian_Repair <br /> Show Numbcr(p)o/lirfures Show Numbrr(M�o//ufwes <br /> A/C-mr handling unds Todct <br /> Forced air systems I [3athtub <br /> � Gas piping I Lavatory(wash basin) <br /> Waler heater � Shovmr <br /> Gas lireplace I Kitchen sink&disposal <br /> Gas iange D¢hwasher <br /> � Clolhes drycr � Clothes washcr <br /> Ran9e hood Wa�er heaier <br /> � —� [xhaust lan Smk(servicelbadmop/etc� <br /> Heal pump � Hackllow preveMer <br /> Unil hcater Unnal <br /> Boiler I Dnnking Fauntam <br /> Reln9eration Ploor drain <br /> Woodstove ' Grease trap <br /> Duclin9 � Root drains <br /> Othcr Metlical Gas <br /> —..—____.__. <br /> SPRINKLER / SUPPRESSION SYSTEM Other <br /> Numbcr of Hr.ads Other: <br /> I hne�y cen,ly uiat I i�ave ma,l and eiamned i�i:appLcanon anE know t�e some�o Ge ime antl cormct All pwvr.ions ol laws and o�tlinnnces govermn9l�r lypv ol vrork vnll lm mmP��J <br /> wf�wl�elf�er SpeuLe�1 tiucin or not.Tpn granLnq ct a pCrmit tloes nol p:esume to give Oul�or�ly to violale or wncel Ibe piovision ol any ollier slnle or local law�egul�Un9 Com.lruction <br /> n.,n I a�n autnnutca t�y mr,onner ol tnis popMy lo perlo�m�hc vmik/u�rnucn apP4:alion is rtaac and I complY w��b I�c Staic ConlmUois lari 1B 27 PC W anU 296 i00A WAC <br /> � �G�j�_ <br /> wn. A Ihorizetl Agenl Signalure � Daie O�ev�sr.d 3i?077) <br />