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� � <br /> PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br /> IO�a/ <br /> SITE ADDRESS: PROPERTY Tq%N P <br /> o� ri'f OoM311o�•Soo�o� � - ( <br /> LEGAL far new constructiorc. Short PIaVs�bCivision Lot No._ (attac�copy ol long tegal descnplmn) <br /> OWNER �Oy►�µV `"�p Phone/E�mail H=,�• 3�1 I ''L1-SS� <br /> AOdress �p� �vr.,�.a�v � City/SlatelZip t'1� 1� IGW� <br /> APPUCANT:�Owner OwneYSAgenl Conlraclor _ConlraclofsAgent Tenant.�w+icmraaaien:roimo.�o�uom¢ac»oenoc�woa„ikew�e) <br /> CONTRACTOR T �/£ State Lic.# IUOGOC.110��{L City Bus. Lic.# <br /> Atltlress � �LlZ'( �y � 5 �A �IV I I7 _Phone/Email ZO(�� �iZ�.' �� 11 <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> N/�, Commerce Bld -�"°° '"`.`°�. 'a °�Y -�„"�"` <br /> Phone�E-mail Htr' �y7'��(/ <br /> BUILdING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Exisling Use of Bwltling �'IN�T1�F�w�y HEAT SOURCE: <br /> Proposed Use ot Building M��41 'f��Ly Gas eieanc_ Othcr_ <br /> Bwlding type: _ Single Family _Duplez_Townhouse �(Multi�Pamily _Commercial <br /> Type ol project: _New _Add:tion emodel Repair__T.I. _,Sign_Sprinkler_Cemolition_Change of Use <br /> DESCRIPTION OF WORK(adoinonai space pro��oed on me sack�. <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> .�--- <br /> TypaofProjoct: _Now_Addri.�Alteration��tepafr TypeolProJecl: _Now_Addn _Alteralion Ropair <br /> Show Number(NJ ol/ixfures Show Number(M)o//ixfures <br /> A/C—air handling units Toilet <br /> Forced air systems Bath�ub <br /> Gas pipm7 Lavalory(wash basm) <br /> � Waterheater f� I � ShoHer <br /> Gas fireplace I Kltchen_ink a disposal <br /> � Gas range Oishwash:r <br /> � Clothes dryer I Clotb^_s washer <br /> Range hood 1M1'a�er healer <br /> Exhaust lan Sink(servicelbarlmop/r.tc.) <br /> Heal pump � BackOow preventcr <br /> Unit heater I Urina� <br /> � Boiler Drinkin Founta�n <br /> Refrigeralion � Floordrain <br /> � Woodslove Grease Irap <br /> �ucting I Roof drains <br /> Other Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM o�her <br /> Number of Heads � Other: <br /> 1�ereEy cenM i�at I have�eaA antl e.ammeC I�is appiicaimn an0 know I�e same to Oc Ime anC mned All prov�sions ol laws enC oroinances govem�.ng t0is tyDe ol wo�M w.il De comp:ietl <br /> wit�w�cl�cr speMeO nerein or nol Tt1c granlmg ol a Dennit Eces nol presuma lo qrve aulnonly to vio�dtc or Wncel tllo pronsion ol any olner slalc a IDCdI law IegulaUng consimtlion <br /> T�al l am awnonzeE by Ini owner o11Ms pmpeny lo petlo�m IOe work fo�wnu�aDGbwiwn Is ma0c anG 1 mmply wM I�e State Conliaclars law 1B 27 RCW and 296 200A WnC. <br /> �'„� �..�.r� loig�,(,� <br /> OwnerfAuthorized Agonl Signa W ro Oa�e (Revised 3R07J) <br />