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� � <br /> PERMIT APPLICATION <br /> BUILDINGIMECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everetlwa.org <br /> SITL ADDRESS: PROPERTY TAx N P RMI7 k <br /> � � � � <br /> LEGAL lar new conslruclian�. Short PlaVsubdivision Lol No._ (�'lach copy ol long legal tlescnption) <br /> OWNER Q PhonelE�mail <br /> naa«ss I IG G .: c��Y�si,iaz�v -' — A P1 <br /> APPLICANT: Owner _Ovmer'sAgenl _CoNraetor _Conlraetor'sA9en1 TCf1�011mvslpmnaoaloucrolccnsenllrominoownuuC�woAlntlmspaco� <br /> CONTRACTORCnH 1�S N �"'�- �-- �Q NI✓ l✓S Y O �. <br /> State Lic.# Cit Bus. Lic k <br /> nadress p�a' �X G s Phonel[m�il �1J / �j c'J <br /> s.s' <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT �pG c�3I JfC�� <br /> ,SPb�VGt(j �=1YyNOwt7J� <br /> Ph�ine/E•mail eA �y+.�t(Ir � i <br /> BUILDING PERMIT APPLICATION CONfRACT PRICE OF WORK <br /> Exis6ng Use of Euildmg HEAT SOURCE: <br /> Proposed Use ol Bwldmg Gas_ Eleclric_ Olher_ ___ <br /> Bullding type: _Single Famdy _Duplez_Townhouse _Mulli-Family _Commercial <br /> Type of projecf New Addition _Remodei _Repair^T I _Sign_Sprinkler_Demolition_Change of Use <br /> DESCRIPTION OF WORK(adtl�honal spncc prov,Ucn on the back) <br /> QPc� wAti�2 Sf� Q P+�S ��.JT <br /> MECHANIGAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type al Projecl: _New_Addn _Alteralion_Repair Type of ProjecL _New_AAdn _Alteration_Repair <br /> Sbow Numhcr(a)of Grfurrs S6ow Numbcr(kJ o//ixlwes <br /> NC -av hanaling units Totlet <br /> Forced au sysiems � 13a1htub <br /> Gas piping Lavatory (wash basin) <br /> Water hea�cr � Shower <br /> Gas hreplace I Kdchen sink 8 disposal <br /> Gasrangc I Drshwasher <br /> � Clothes dr/cr � Clothes v+asher <br /> Ranyr.hootl Waler heatr.r <br /> —� Exhaust lan Sink (service/bar/mopletcJ <br /> Heal pump � Backilow preventer <br /> Und heater Unnal <br /> Boder Dnnkmg Pountam <br /> � Refngcralion Floor drain <br /> Woodslovc I Grease trap <br /> Ducting � Roof dr.ms <br /> p���P� Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM Ou�rr <br /> Number of Heads � Olher. <br /> I�cre�y cetlJy Ihat I�ave reatl anE r.ammetl t�u apphrason nnd knew I�e:ame lo be uue and r.orrecl All piovb�ons o���ws aM o�tlmanrr:govermn91M5 type 01 woik wi9 Oe[omplred <br /> wA0 w�et�e�speuLeC�erem or nol 1he gianeng ol a D�rmn doe,noI presumc l0 9rve autnonly to violale or CancG mn provivon ol uny otlicr:Iaie oi bcal lavi�egum'in9 mnslmUian <br /> T�a1 I am aWnorixed Ey I�e owner ol mi: m e l0 peAo�m Ilte work lor•xn4�appbtalion i5 ma�le anE I Comply w�:�Ilic Slalc Conlrazlo!s l'uw IB 27 1iLVJ an�79G 200A WAC <br /> OwnedAuthorizotl A�ent Signature Uale (Rrwsetl J/?O1JJ <br />