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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 425-25T-8857 wv:•��.everettwa.org <br /> SITE ADDRESS: PROPER TA%p P RMIT 0 <br /> 5'2N " <br /> LEGAL lor new conslruction: ShoA PlaVsubdivisionr�.{K !�� � 273Lot No. ��(attach copy ol lang Iegal descnption) <br /> OWNER PhonelE•mail <br /> AOCress CirylStatel7.ip � Gll <br /> APPLICANT: Owner _OwnefsAgent _Coniractor Contractor'sAgent Tenant(m�siaoxaeaier.eroi�o,umo-ommemmermao.onmme:pacal <br /> CONTRACTOR L State Lic.# Cit Bus. Lic. # <br /> I• ,I 6 eKa �i N+���.C��1 <br /> Adtlress �(� Wp !� � Phone�Email •�i r� <br /> TENANT BUSINESS AME CONTACT FOR PERMIT <br /> �,av� �a.a�,u, <br /> Phone/E-mail t5 2�9 /�9�h-��4K� «ESE <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK I O � <br /> Exisling Use o(Building �F3e AT SOURCE: <br /> Proposed Use of Building SG2- Gas_ Electric_ Ot�er_ _ <br /> Building type: li Single Family _Duplex_Townhouse _Multi•Family _Cnmmercial <br /> Type of pro�ecC New Addition Rer.iodel Repair_T.I._Si n Sprinkler_Demolition Chan e of Use <br /> DESCRIPTIONOFWORK(addrtiona�spaceproviaedonmeback�: � �.e <br /> �veu�artAc�n h�as - 2.G42 _ 2�}x 2 = �°X <br /> MECHANICAL PERMIT Ae'PLICATION PLUMBING PERMIT APPLICATION <br /> Typo of ProJecL• _New_Addn _Altentlor_Repalr Typo of ProJecl�. _New_AdOn _AltoraUon_Repair <br /> SAow Number(N)o/flxfures Show Num6er/M)o/lixfures <br /> A/C—air handling unils Toilet <br /> Forced air s stems Bathlub <br /> Gas i ing Lavatory(wash basin) <br /> Water heater Shower <br /> Gas fire lace � Ki(chen sink&tlisposal <br /> Gas range Dishwasher <br /> Clothes dryer Clothes washer <br /> Ran e hood Water healer <br /> Exhausl fan Sink(service/bar/mop/elc.) <br /> Heat ump I Backllow preventer <br /> Unit heater Urinal <br /> I Boiler Drinking Fountain <br /> Re(ri eration Fleordrain <br /> l•Voodstove Grease trap <br /> Ductin Rool drains <br /> Other Mediwl Gas <br /> SPRINKLER i SUPPRESSION SYSTEM � O�her: <br /> NumberofHeads � Other <br /> I�ercCy cenrty I�at I�eve rcaG enC eaamned this appliwbon and know t�e samo to Ee Vue and wrcect.All pravisions af laws end oN.�ances yaveming Ihis lype ol woik me be comp4M <br /> w't1 wTclticr 5D � rein or nal.TTe granliny ol a Dertnil tloes not Dresume lo grve au�hofY,y lo violate w Cenul lile pmvision oi any ct�er slate or lowl law regulalinp CAnslrutlion <br /> T�at I a ut ued�y 1� owner olt�i proDerry 10 perlorm I�e wat for whictl apDhcation is maae ena I campy wA�me Slete ConVaarns law 19 27 RCW an0 296.200A WAC. <br /> I`�i <br /> � SE /� <br /> Owner Au orized..9ant Slgn ture � Uate (ReviseUY2013) <br />