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� � <br /> PERMIT APPLICATION <br /> BUILL'iNGIMECHANICALIPLUMBING/SIGNISPRINKLERIDEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br /> a ��q �► <br /> SITE ADDRESS' .�y A ' PROPERTY TA%M PERMIT M <br /> �1�1 R�W\� /�L O <br /> LEGAL lor new conslructiorc, Short PlaVsubtlivision Lot No._ (allach copy o�long legal tlescnptian) <br /> OWNER (�,� �� Phone/E•mail [,ZeL Q�2—(b C� '��—�01�4M��1�rt' <br /> Adtlress l'l\� ��ewlT1 /�t Ci1y/Slale?p �,pk SZQ <br /> APPLICANT: Owner OwnePSAyeni _Contraclor CoNractor'sAgent _TenanliR.:,:ic.���aoaion.roi�o�::-um.mmoo.�rrmnowe.M��m�:;�:er <br /> CONTRACTOR Slate Lic.# City Bus. Lic.# <br /> Address P�one/Email C3(r0 �p3�^ �."rJ0( <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> �� � ` �15,�'D u� PhonelE�mait �ZG7��`�AMd� lz0{I 9bz—�L�-( <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Exrsling Use ol Buildmg �GSs�Rv2A�i l HEAT SOURCE. <br /> Proposed Use of 6uilding �t 1Fvl.t� Gas_ Electric_ Ol�er_ <br /> Building type: _Single Family _Duplex_Townhouse _Multi•Famity OS Commercial <br /> Type of pmjecl: New .4ddition Remodel K Repair_T.L_Sign_Sprinkler_Demolltion_Change of Use <br /> DESCRI PTION OF W ORK(addd�on.I spaco provided on Ihe�atk): <br /> 11�15�`Rw. �e_ � <br /> MECMANICAL PERM!T APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: ,_Naw_Atldn _Alle�alion_Repair Type ol Projecl: _New�Addn _Alleratlon_Repair <br /> Show Number(p)o/lixi�res Show Num6er(M)o/lixfures <br /> NC—av handling unds I Todet <br /> � Forced air systems E3alhtub <br /> Gas pipmg Lavatory(wash basin) <br /> � Water heater Shower <br /> Gas fueplace Kllchen sink 8 disposai <br /> Gas range Dishwasher <br /> ! Clothes drycr � Clolhes washer <br /> Ran9e hood Water heater <br /> [zhaust fan Sink(scrvicMbarlmopletcJ <br /> Heal pump Backfiow prevenler <br /> Und healer � Unnal <br /> � Ooiler Drinkmg Pouniain <br /> � Refngeration Ploor drain <br /> Woodslovc � � Grease trap - <br /> Duchng � Roof dreins <br /> Olher � Medicai Gas <br /> SPRINKLER / SUPPRESSION SYSTEM � omcr <br /> Number ol Heads � Other: <br /> I LemEy cetlAy I�al I hove icatl an0 e.amme0lhis app��cTion anJ hnow I�e same to be Irue antl coircct All p�ov2ions nl la.vs And oiU�nances 9oveming I�i:lypC ol work wi I I�e wmobeil <br /> vril�whelhCr speuGetl naein ol nol The qranting al a Dermit Eoe;nol D�esume�o gne nNnor�ty lo v�ola�e or canrel Ino pravision ol any nln:�r sl:ile or Iocal Iaw iegulBL�g co�slmc4on <br /> Toa�I nm avi�omed�y�rv�nwper ol i�it p�opetly ro petlorm I�e wmk IOr w�rth apPbcaUon is maac ana I mmply wiln I�c Slatc Contracto�s lari iB 17 NCW antl 294200A WAC. <br /> ���--,,.��Z_ Z.,�.c`1 <br /> uthorizod Agent Signature Date (Rev�setl JR01J1 <br />