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� � <br /> PERMIT APPLICATION <br /> BUILDINGIMECHANICALIPLUMBINGISIGNISPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everelt, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 0 PM —1 —� Z <br /> SITE ADDRE55: � , �� PROPERiv TA%p �RMIT x ' <br /> 1 <br /> LEGAI for new construclion: Shotl PlaVsubtlivision lol No._ (ailach copy o�lonq Icgal description) <br /> OWNER e� I Q � Phone/E-maA o�-979- 5'9(� o Q 4/1 CO�'7C4�.�1 <br /> �dd«55 5 w'�ff� �f L'2 ���y,5����,Z,P ur�l� U �'�n r <br /> APPLICANT: Owner Ownei'sAgenl Conlractor Conlraclor'sAgenl _Tenanllmosiv�o�acwienoroimns��,nraninewnermaowuMininaspac.l <br /> CONTRACTOR e� � L&I lic.N COE 8us. Lic. M <br /> Address PhonelEmail <br /> TENANT BUSINESS NAME CONTACRT FOR PERMIT �OG -/�7�- '�f/a O <br /> N �,rc ' L�� �1�� QCa�co3� Ac� <br /> �'"QJ/\ n ('�+1 , p 1jL�((�[� PhonNE-mail �/ 4�) <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK � � /oCh�. o0 <br /> Existing Use of Bwlding � �� 1 H[nT SOUR�E: <br /> Proposed Use of Builtling�Yfl��l Gas _ Eiectnc_�C Other_ <br /> 9wlding type� _Single Family _Duplex_Townhouse �Mulli-Family _Commercial <br /> Type ol projecl� New _Adddion _Remodel _Repair__T.i._Sign�Sprinkler_Demoldion Change ol Use <br /> DESCRIPTIONOFWORK(add�no�a�spacopm�idedoniheback�. ��'d L�14�� �� `f'� �l✓��d� SPq�L'^ <br /> a ��ni� �s . �l�n,�;� � F�r ha�-w�� a S;.,fr <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Pro�ect: _New_Addn _Alteration_Repalr Type of Project: _New]��ddn _Allera�ion_Repair <br /> Shaw Number/p)of lufures Show Numbcr(a)oi liYfures <br /> NC-air hanAlin9 umis Todel <br /> Forced air systems �������� - <br /> Gas piping � Lavatory(wash basin) <br /> Walcr healer � Shower <br /> Gas firepiace KM1chen sink&di;posal <br /> � Gasian9e Dishwasher <br /> Clolhr.s dryer � Clolhes washcr <br /> ange hood Watcr heater <br /> aust lan Sink(service/barhnopletc) <br /> Hea ump Backflow preventer <br /> � Uml he er � Urinal <br /> f3oiler � Diinking Fountain <br /> Refrigerahon �� Flaor drain <br /> Woodstove Grease Irap <br /> Ducling � Roof drains <br /> Other___ � Med�wl Gas <br /> SPRINKLER I SUPPRESSION 5YSTEM othec <br /> Number of Heads OIhrC <br /> I M1ereLy catity I�al I lmve read and e.aminetl IN5 apP4oahon anE Fnow I�e same lo�e Ime and coned Ail piovi:ions ol laws anJ onfnanres goveminq thi:lype ol wmM wJl hp comVl ed <br /> en�h x�el�er SpMdie4 tiereln or nol.The 9iantin9 0l a De�mJ Eoes nol pmsume to ylve autheniy�o vio�ale o�canr.M��c piovis:on ol any ot�cr siale o�local law¢gulatmp wnslruciron <br /> ihal I am au��oY .rl�y Ihe owner o110is properly lo prrlorm iho wmF fo��nc�h upp�ication Is maJe an�1 campi�wn�I�e S�n1e ConVaUors La'•v Itl 271iGVJ anG 79G 200�VJAC <br /> 1�--- 9-5-/� <br />