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PERMIT APPLICATION <br /> BUILDINGIMECHANICALiPLUMBING/SIGNISPRINKLER/DEMOLiTION <br /> CITY OF EVERETT P[RMIT SERVICES <br /> 320u C;edar St., Everetl, WA 98201 425-257-8810 FAX 425257-8857 www.everettwa.org <br /> APPLICATIONS ARE ACCEPTEU FROM 8 AM TO 4 PM <br /> SITE ADDRESS: PROPENiY TAX A PE IT/ <br /> R10& �S�- D vf ( � <br /> LEGAL lor new consWctio�: ShoA PlaVsubdmsian Lol No._ (atla�t�py of long lagal desmp0on) <br /> OWNER a1�ic�C �CG%cR PhorrelE�mad ,Z3..237-9/7� ����Gls���MS ,to�« <br /> naa�ess R I D Fl 1.I3� re.o,v D qU 2 cMsuir�ao v r.?+r� tJ.4 5'�20 / <br /> MPLICANT: O�mer _OMncfsAgen� �Conirar�or _ConuaCoraAgeN Tcn.intpmnt.mde.w�x.ma.v.eetmmu.co.�m�om�ranmesoarni <br /> CONTRACTOR O V.QZ Z� �a�u�.a G03 -3s 7-/G3 COE Bus Uc.t7O3e�32 <br /> Address 39iz G,g '� �e ,UC` /�D " Jvi�fr p/� �.T7D Pnm�many��� �� ,pc,c.n••t <br /> TENAN7 BUSINESS NAME CONTACT FOR PERMR <br /> y.?.�'3.a'1-7fP� <br /> P�one/E+nail V�,!.007✓J <br /> BUILDINGPERMITAPPLICATION CONTRACTPRICEOFWORK G/.�O.OD <br /> Existing Use o1 Budding_ S�wlt�L �i►�i�y HEA7 SOURCE: <br /> _ + <br /> Proposed Use of 6vildina 5?�`� Gas Elenric__ Other_ <br /> Bwlding type: �Singie Family _Duplex_Townhouse _Multi�Family _Cammercial <br /> T pe of pro ecl: Nc�v 4AdNon Remod.M. Repair_T.I._Sign Spnnkler DemoliGon Chan e of Use <br /> DESCRIPTIONOFWORK(addinona�spa pmvidedon�hebaU : ��y,� LX/S�� I�UL�NSn2I�w�'���_"� <br /> �Pf�/4xz L'x�'sr.%„� 9as ����s�� �,,��� NC.,�. �� "1 <br /> , w,�� ��, e�'�� d1 .p.;�e��o.n P,eo�nN< <br /> ����o f`'s�..G; J�w�! z �r,o�nz g � <br /> MECHAPlICAL PERMIT APPLICATION � PIUMBING PERMIT APPLICATOON <br /> Type o1 ProJe..t: _New_Addn ]�AMeratlon_Rrpair Type o1 VroJM: _Ne�v_AdAn _A1lcratlon_Repalr <br /> Show Number(/)of firNns Show Numbei(11)d RrNres <br /> A/C—air handiing uniLs Toilet <br /> / Forced art s tems BaNtub <br /> ,Q, Gas piping La�atory wash basin <br /> W atci hea�er Sho.vCr <br /> Gas fire lace Kitchen sink 8 dis sal <br /> Gas range Dishwasher <br /> Clothes d cr Golhes washer <br /> Ran e hnod Water heater <br /> Exhaust lan Sink serviu•Jbadmop/etc.) <br /> Hral pump Badcfiow prcven:rr <br /> Unii hraler Unnal <br /> Boiler Drinkin Founlain <br /> Refri cration floor drai� <br /> Woodslovc Grease tra <br /> Ductin Roof drains <br /> Other Mediral Gas <br /> SPRINKLER /$UPPRESSION SYSTEM omer <br /> Number of Heads Other <br /> 1 hemby ceNiy Ihal I have read and ewmned IAs app�t'vn and knor tlie same In be W e and ca�xt M pmvicims ol laws nnd adnances gwemmg Mix rype ol worh wll be compbeE <br /> �Mh Mhetl�er speufetl�crem w nU The 9�nic�g d a pamh tlocs�rot Wesume tc grve nuCiviry In vul�le m ana�rt+e�aavkm ol arry dlrn spte v bc�l Lrw rtguqMg mnsbucLon <br /> That I am aNhoriwd by I�e am�Y ol tha�RV erty m OM�!he woM1 Im wnid�apptie�lixi is matle antl 1 mmply vntl�IAe Slala Centradors law 18.77 RCW a�d 796.700A W AC. <br /> ��y��y <br /> eHAulhori Agent Signature Dalc � �Rehsed fi?072) <br />