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� • <br /> PERMIT APPLICATION <br /> BUILDING/MECHANICALIPLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everetl, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br /> SITEAODRESS: PROPERivTA%p P MITa <br /> I 2 7 Cs-2.� 5 0 - � <br /> LEGAL tor new construction. Snort PlaVsu�division Lot No._ (atlach copy ol long legal tlescnplion) <br /> OWNER l ��n/� l� �LCe Pnone�E-maii U,�.Sr �{a o2 U �� <br /> Address Gty/Siale2p <br /> APPLICANT: Owner OwneYsA9ent _Conlra[tar _Conlractolsllgent _Tenanllm�sic�m�ao�ieiro�ci��:om��mm„o..nermm�.�n�omo<p„c�� <br /> CONTRACTOR /�UG✓� Y ��^rijr�✓' SlateLic.#MDC/�!/ �+r'jj�j�� (..) Ci! Bus. Uc. ?F�53(o3s <br /> nddress 17� �S yr`�S1- SC Sno �n� � LJ �� �l Z�tU PAonelEma �36� � �( � �. <br /> S � I/�' IYCa:.� ��"1 1 M . C O <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Phonc/E�mail <br /> BUILDING PERMtT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of Buddm9 H[AT SOURC[. <br /> Proposed Use uf�uilding Gas__ Eiectnc__ Other_ <br /> Bwlding type- �Single Family _Dupiex�T.�wnhouse _Multi-Famity _Commercial <br /> Tyve of pro�ect New Addition ✓ Remotlel Repa�r_T.I. Sign_Sprinkler_Demolition Change ol Use <br /> DE�IPTION OF WORKr(addaionai space pmv�ded on me Dack). <br /> .�- nj�'L (1 � � d-�., ., Z �S�-.L,,iZ �'V. �'�oa:/� �:v. <br /> z ,.s� i� i3uv ; n ��.,. � s;.. K <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of ProjecC _Nr+v_AdAn _Alterotion_Repai� Typo of Projoch _Now_Addn _Allcralion_Ropair <br /> Sfrow NumCer(a)ol�xfures Show Number(N)ol(xtures <br /> A/C—air handling units i Toilet <br /> � Forced air systems � Balhtub <br /> Gas p�pir.9 � I.avatory pvash basin) <br /> Water heater � Shower <br /> � Gas fireUlace Kdchen s�rk 8 disposal <br /> Gasrange � Dishwashci <br /> � Clothe5 dryer Clothes washet <br /> Range hood � Wa�er heatcr <br /> � f-xhausl fan Smk(service/badmop/e�c) <br /> Heot pump � 6ackflow Preventer <br /> Umt heater Urinal <br /> 8oiler � Ormking Fountain <br /> Refngera�lon Floor drain <br /> Woodstove ! Grease trep <br /> Ducting � Roof drains <br /> Other Medical Gas <br /> SPRINKLER I SUPPRESSION SYSTEM omer: <br /> Number of Heatls I Olher: <br /> I�em�y ce�M������nve read ond uam�ned t�u appllr�non antl know ihe;amu lo�o trve ond cotmcf.An provision,ot lew.onE orCinunces goveming I�s lype al wo�k w:i�e comp:.rtl <br /> Hrp�etnerspenlKanercinarnot TnegrammyalapermnOoe.nolpiesume!og�.veaul0onrylana!alcolotnceltneD�ovlslonolnny0mcrstalcoNocallawrrgWalingconstnstion <br /> P��ai l em aul�or¢eC Dy Ne v«ncr ol iNs pmperty to pMorm No wark lor wMCA aDD�'W��on I:maOc ana I comDH wM I�e Slale Contractors Law 7B 27 FC W and 2?6 200A N'TC <br /> � /� �-C_ y-.z�-is <br /> OwnedAulhorized Agent Signature Dale (Revis^d 3/101J1 <br />