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PERMIT APPLICATION <br /> BUILDINGIMECHANICAL/PLUMBING/SIGNISPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES 1'�—�6 �I'Z <br /> 3200 Cedar St., Everett,WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS: PROPERTV TAIf p PERMIT M �` <br /> �1\�1 = , C�RN;) (a = � ercif �1�7� V <br /> LEGAL tor new wnslruction: Short PlaVsubtlivision Lot No._ (allach copy ol�ong lepal Cescription) <br /> OWNER S� -�A �l.\LC-f1 PhonelE-mail -� V� �� � � <,� <br /> ddress Z \�{ - C�{J1� IZ�� �' City/StatGZip r J� ✓CL� WA ���Z�� <br /> APPLICANT:��Owner OwnefsAaent _Coniractor ContractoYSAgeN _Tenanlcm�s�v��A••*mra�omemnomu»o..,«maowni,u,.�p.a� <br /> CONTRAIITOR C��� �� �--.�� L&I Lia# COE Bus.Lic.8 <br /> tldress ,� II�I C. �L�nN�7 r�"�r _ PhonrJEmail <br /> TE ANT BUSI E 5 NAME CONTACT FOR PERMIT <br /> P�one/E-mail <br /> BUILDINGPERMITAPPLICATION CONTRACTPRICEOFWORK �6C0-�'0 <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building Gas Eledric other <br /> Buildingtype: ✓ SingleFamily _Duplex_Townhouse _MWIi-Family _Commercial <br /> T pe of ro'ect: New Addition �Remodel Re air T.I. Si n S rinkler Demolition Chan e of Use <br /> DESCRIPTION OF WORK addirional space rovidetl on tne back): <br /> �Ve.:S c��,.�( \i�� Pno'�:1�.� l.v ��t'� �OJSt , (iCIG Inr, �C�-� Uv"�� <br /> C1'lG� �zY�k-��,1..5� �,�1��.'�-`—i- �-•.��-e� <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> TypeofProJact: `New_Atldn _Alteratlon_ftepair TypeofProJect: _Naw_Addn _Alteratlon_Repalr <br /> Show Number(p)o!llxfures Show Number(N)ol Ifxtures <br /> A/C—airhandlin units Toilet <br /> Forced air s stems Balhtub <br /> Gas ipin Lnvato wash basin <br /> Water heater ShoN•er <br /> Gas fre lace Kitchen sink&dis osal <br /> Gas ran e Dishwasher <br /> Clolhes d er Clothes washer <br /> Ran e hood Waler heater <br /> Exhaust fan Sink(service/badmo /elc.) <br /> Heat Pump Backflow revenler <br /> Unit huater Urinal <br />� Boiler Drinkin Fountain <br /> Refri eratio� Floordrain <br /> Woodstove Grease tra <br /> Duclin Roof drains <br /> Olher Medical Gas <br /> SPRINKLER I SUPPRESSION SYSTEM Other: <br /> Number of Heads Olher: <br /> I hereby rntlrty t�al l hava read nntl ezeminetl t�b npP�Kotbn ond know Iho seme to ba We end cone<L All pmvisions ol lawa end orOnencee Oovemn9 Nu rype olwwk wilbe compfe0 <br /> wilh wfiet�er spedfmE herein or nol.Tho pranlinp ol a pertnil Eoea nol pmsurtw b 9ke aut�o�Ry to Wolete or cnncel Ihe proWsion ol eny other slate w local law re9����8�onsbudion <br /> That I am auUonzed Ey Iha ownerol Ihb proDerq�lo penortn t�a wo�%lorwhkh app5calion b ma0o an01 compy wl�Ne Stalo Contradon�ew 1B.Y7 RCW an0 2B6.YOOA WAC. <br /> c�_ ��`��;�::� � i 21 a�l aJ,Z <br /> OwnedAutho�ized Agent Signalure Date (Revised 6/2072) , <br /> � <br />