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PERMIT APPLICATION <br /> BUILIDING/MECHANICALIPLUMBING/SIGN/SPRINKLERIDEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 32Q0 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br /> SITE ADDRE55,?//9 E ��� PROPERir TAx p !— P ��La Z– <br /> �� 3 <br /> LEGAL lor new com:lmctiorc S�ort PlaVsuAdnls�on Lol No_ (allach copy ol iong legal descnption) <br /> OWNER VVI4S'}�u� �-a�nd .l)C.]. G.�–� Phone�E-mai� yZ$'Z�/`�-0�"�Cl `1o�inPS .fnf�r��SS oc� <br /> noa�o55 �o IIoa a! � cny�si�i�rz�N M��� Cree�C l.v 98ogZ <br /> APPLICANT:�,Owrer OwneYSAgen1 Conlractor ContrattvfsAgen( Tenant�m�+ic�oraeaionaoico�,00irtom�oa..�<<ocawonnvaso.,�� <br /> CONTRACTOR 5% ✓Gf��P ��b�+rs State Lic.# Sr v+��'JE ���KE Gry Bus. Lia # <br /> AtlUress Sqrv1[ Phone/Email �..�P. <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Phonc�E-mail <br /> BUILDING PERMIT APPLICATION CONiRACT PRICE OF WORK <br /> Existing Use ol Budtling _ HEAT SOURCE�. <br /> Proposed Use of Budd�ng Gas._ Eiectr�c_ Omer_ <br /> 8uddin9 type: _Single Family _Duplex_Townhouse ._Multi-Famdy _Commeraal <br /> Type of prolect New _Add�tion _Remodel _Repair_T.I._Si n_Sprinkler_Demolition_Change of Use <br /> DESCRIPTION OF INORK(aco�nena�spac�providedon me eack): <br /> �e�o ex�s �;�S 1-�-� � � g� -I <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Pro�oct: _New_Addn _Altoratlon_Repair Type ol ProJect: _New_Adtln _Allaratlan_Repair <br /> Show Number(N)ol firtures SAow NumDer(M)ol fixtures <br /> NC–air tandling unils Toilet <br /> � Foroed air systems Bathtub <br /> Gas pipin Lavalo (wash basin) <br /> � Waterhealer ShoHer <br /> Gas fireplace 1 Kdchen smk&disposal <br /> Gas ronge I Dishwasher <br /> Clolhes dryer I Clathes washer <br /> Range hood , Water heater <br /> Exhaust fan Sink Iservice/bar/mop/elc) <br /> Heat pumD I Backllow preventer <br /> Und�eater I Urinal <br /> I Bntler I Drinking fountam <br /> I Refrigeration i rloordrain <br /> � Wootlslove ! Grease trap <br /> Ductin Roof drains <br /> Other I A7edical Gas <br /> SPRINKLER I SUPPRESSION SYSTEM � Other <br /> Number ol Heads � Olher <br /> I hemEy cenity Ihal l have reaC anE e�amir.ed I�is app!Iw��on and know I�e same to Ge irue nnd mrrect.All pmnsions ol Wae ond orCmances govem�ng t�is ryGe ol Mo�/.wll Ce compbed <br /> xitn wnclnrr spelaryeC herein or not Thc granimg of a pe�TM1 tices nol O�esume b give auinorny lo viWale cr[anu�I�e provision oi any ot�.ci slale or Ipcal law lequlal�n�wnsVuctmn <br /> i�al l am aN�on2eC Oy Ine owne o�I�is pmC�rty to peAonn t�e woiA for Hnicl�appliWuon is maae ana I wmply wnn I�e Slale Cemraclon LaH iB 27 RCW anG 296 2IX`A WAC <br /> ,,� fl/ �� .z �q i ��� <br /> Ow rlAulhorixed Agont Signature Date i+�evisedY10t3; <br />