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� • � <br /> PERMIT APPLICATION <br /> BUILDINGIMECHANICALIPLUMBING/SIGN/SPRINKLERIDEMOLITI()N <br /> CITY OF EVERETT PERMIT SERVICES Q�.w�yo5-�'I <br /> 3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 �wdw.everettwa.org <br /> S -9 �� <br /> SITE ADDRESS� PROPERTY Tl1X tt PE T <br /> t� I�FO�- I <br /> LEGAL lor ne�v consiruclion: Shor�PlaUsubdivision Loi No._ (al�ach copy ol 1on91egal dc5a�p(ion) <br /> OWNER � / ��� PhonelE-mad l�Z,�— y—���'— 9Q D � <br /> �ddiess �, <br /> Gly/Slate/Zip �✓�d— ,1�'Z'� <br /> ApPLICANT:�ner Owner's/lgent Con�raclor _Conlra IoisAgenl _TenaNlm�si�:eraaa�cieroimnse�u:ommoownc�ioaowon:ninospace� <br /> CONTRACTOR f� � � � � � � ` �w S�ate Lic. t! cL � � l -CiIY Bus. Lic.N <br /> Address <br /> �1 ��an � 2�, I�--�� i,� �Jh ,SZ�i 1. PhonelEmaJ - <br /> TENANT BUSINESS AME CONTACT FOR PERMIT _._-� u �� <br /> �afi1S �1,cUn S �.S C, <br /> Phonc/E-mail �h � _ —` I � — i �l � 1 <br /> BUILDING PERMIT APPLICATION CONTRACTPRICEOF WORK�Q�J - a d —. <br /> [xislin9 Use of Buddm9 HEAT SOURCE�. <br /> Proposed Use of Building Gas__ Electric_ Oiher__ <br /> Rudding lype. _S�ngie Famdy _Duplex_Townhouse __�vlulti�Famtly .__Commercial <br /> Type of pro�ect tlew Addition _ Remodel __Repair_T I.__Sign_Sprinkler__Demolnion__Change o1 Us�� <br /> DESCRIPTION OF WORK(addrt�cnal space pmvitletl on fhe backJ .�_1--�—�J=��-. �c�_�""" n--t��-'1''� � <br /> _+_ -rycac�.c �1 ' Z'�-- <br /> ,��_��� � `�-�� t�^-� °h�di""-'°� �o ue� ti1Ja� �L. � �� � <br /> i� .,-�, Lf,.MM� � �a-��'e � <br /> MECHANICAL PEi2MIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type ol ProjecC _New__Addn _Allcralion_ftepafr Type ot ProjecC _New_AdAn _Altcration_ftepair <br /> Show Nwnbcr(MJ o//i..Nms Show Numher(p)ollixfures <br /> NC-air handhng unils I Toi��.et <br /> I Forced air systems � Oathtul� <br /> � Gas p�ping I Lavatory(wash basin) <br /> � Wa�cr healer j Shower <br /> Gas freplace � Kiichen s�nk&aisposal <br /> � Gas range Dishwasher <br /> I Clothes dryer � Clolhes washer <br /> � Rangc hood I Waten c�ater <br /> � Erhaust fan I Sink(scrvicclbar/inop/etc.) <br /> I �����n���P � Dackflow prevenlcr <br /> � Und nealer � Uiinal <br /> � (3oiler Dnnkmg PouNain <br /> � Relrigeration � I'loor drain <br /> � Woodsluve I Grease trap _ � <br /> Uuc6ng � Roo(diains <br /> � Olhcr,_ ��Aedical Gas _ <br /> SPRINKLER / SUPPRESSION SYSTEM j O�her <br /> Numhcrol Heads � Olhcr. <br /> I hemby cendy tnzi I hme reaJ and Gnmmed Ihu apf!icai:nn and Ino�.v Ihe samu l0 6e Ime nntl mnCU A'I piov�sions ol lavr.and or0inances govemm9lhis lype oiwork wdl l C wmpSeJ <br /> witll whclhet spculictl hcre�n or ocl.The 9r0nhng ol n D^m'��tlacs not presumc la 9ivc dutnouly Io v�olale or wnccl inc provlsion ol�ny othcr,lalc or lou�l la�.v iegolnli�9 mn5lru:l�on <br /> T�al t am aul�outc��y the ow0er ol i�is pmpetly lo perlorm I�e w0ik fo�wMcli applmalion Is maae anC I comply wN�P,e Slale Ccnlwc�o�s Ww IN 7/RCW.nJ i9f>700A WAC <br /> `�A� S_� -:)o l`-` <br /> Ownerl�uthorized Agc t Siynaturc —�atc (Revised 3'%01J) <br />