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PERMIT APPLICATION <br /> BUILDING/MECHANICALIPLUMBING/SIGNISPRINKLERIDEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 425•257-8810 FAX 425-257-8857 www.everettv+a.org <br /> SITEADDORESS: , C7 IU �.�vQ(fT�� WI� I�Z�I �QE�TAXd S 0.2. pQO P RMITe a � <br /> LEGAL lor new cor.slruction� Shod PlaUsubdivision Lot No.� (altach coOY ol long Icqal tlescripUon) <br /> OWNER �+/ LUCr t /(ELL` N�ERC/�2 PhonNE�mail WWM ¢Rc1ER_ SLmsn �cewt WZ`� 1�? <br /> q �73 <br /> Aaaress q Vi'ew pR� C�Iy1S1ate2IP ��,rQt+ W� 4&Zo <br /> APPUCANT:�Owner Owner'sAgeni Contraelor Conlraetor'sAgenl _Tenanl�r,:i��.sco�iererrce�se,�no�irec,�eraa.orv ,:^esca:��� <br /> CONTRACTOR O W `�`R-� State Lic.# City Bus. Lic. # <br /> AdCress PhonelEmail <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> PhonelE-mail <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WOR �d <br /> Exisling Use of BuBding �3 a �� L HEAT SOURCE�. <br /> PropoSedUseo(Bwlding�Qrv�0�1,5 � Gas___ Electnc_ Oiher_ _ <br /> Budding type: _Single Famlly _Duplex_Townhouse _Mulli•Family _Commertial <br /> Type of projecY. New Adddiun _Remodel _ftepair_T.1. _Sign_Spnnkier Oemolition_Change of Use <br /> DESCRIPTION OF WORK(aca;honai space F�ov+ded on me back). J <br /> �.z�f`�o�� Sh Cn /1 CIA G�= �o'��LG�eGt ) <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type ot ProJect: _Naw_Addn _Atteration_Ropalr Typo ol Praject: _Nnw_Addn _Alteration_Ropair <br /> Show Num6er(M1 0l lixfures Show Number(M)o!li.tures <br /> A!C—air handlmg unils Todet <br /> � Forced air systems Bathlub <br /> Gas piping Lavatory(wash basin) <br /> � Water heaier Shower <br /> Gas fireplace � Kitchen sink 8 d�sposal <br /> Gasrange Dishwasher <br /> Clothes drycr i Clothes v:asher <br /> Ran e hood � Waler heater <br /> Exhaust fan I Sink(servicelbadmop/etc) <br /> Heal pump � [iackflow reventer <br /> Urnl hea�er I Ur�nal <br /> � Boiler I Drinkin Pountain <br /> I Relrigeration I Floor drain <br /> Woodstove Grease trap <br /> Ducting Rool drains <br /> Other i ��iedical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM j o�her. <br /> Number of Heads � O�her. <br /> I�ereCy ceOM��al I have reaC anE eRamined lAis apD�;���ion nnd Anow Ihe sama to Ce irue anC correct Ah pmHsions ol�nws end oNinantts goveminq t��s IyFo of xork wli�e compi�c� <br /> wnn wheiher specilretl�ere�n or not T�e g�ani�n9 at a permit Eoes nal F�esumo to gne awnorny io vioate or wnccl I�o F�o��sion ol ani o:ter sta,e or local lax re9WaCng consimctlen <br /> T�at I am aul�orize0�y�ne ev:ner o11Ms Dmpetly:o petlortn Ine�md Iw wni<n aDPliwtion Is ma�e an0l comply w.in Ine Stnte Connacfon law IB 77 RCW an0:9G 2WF K'%�C <br /> 2��,�t ��/�//� <br /> OwnerlAuthorizod A9ont Signaturo ate (Rovised320f3) <br />