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PERMIT APPLICATION <br /> BUILDINGIMECHANICALIPLUMBING/SIGNISPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett,WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM J �I U `�Z <br /> PROPERTYTA%p P RMITM <br /> SITE ADDRESS: .. —�� <br /> JU� � <br /> LEGAL lor new construclion: Short PlaUsubdivision Lo1 No._ (altach copy ol long legal Oescription) <br /> OWNER �. „i � c 'nn PhonelE-mail "i 2S-fi7�C' ' S <br /> Address ,3ju$ �, � ,(� . cirylstatelziu Cv 1"� � <br /> APPLICANT:�Own=r Owner'sAgent Contractor _ContractorsAgent _Tenantem���c�+baa�i:roiw�s�mnomm.o+merwao.wn���Ne�c.al <br /> CONTRACTOR �, �n ✓ �:, cwn � L&I Lic.# COE Bus.Lic.# <br /> Phone/Email <br /> Adaress <br /> TENANT BUSINE55 NAME CONTACT FOR PERMIT <br /> Phone/E-mail <br /> BUILDING PERMIT APPLICATION CONTRACTPRICEOF WORK <br /> HEAT SOURCE: <br /> Exisling Use of Building 5_T '� � �� ^B <br /> Gas Elecinc_ Olher <br /> Proposed Use�o(Building <br /> Buildingtype:,\ SingleFamily _Dup�ex_Townhouse _Multi-Family _Commercial <br /> T pe of ro'ect: New Addition Remodel _Repair T.I. Sign Sprink�er_Demolition_Chan e of Use <br /> DESCRIPTION OF WORK(ad1tlitional space pm1vided on fne back�I: 1 1 <br /> �l�S�=.I��n� �. i,c�5 +:I'e�'lc.ce i/�ScrT1.: cr� ��SY.'.�� Ch�mrty/h^�^�1� �n ��e vlc.nf. <br /> J <br /> MECHANICAL PE RMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> 7ypeofProJect: _New_Addn _Alleralion_Repalr 7ypeofProject: _New_Addn _Alteratlon_Repalr <br /> Show Num6er(p)o!flxfures Show Number(q)ol flRures <br /> A/C—air handling units Toilet <br /> Forced air systems BathWb <br /> Gas pipin Lavato (wash basin) <br /> Water heate� I Shower <br /> Gas fireplace I Kilchen sink&disposal <br /> Gas range Dishwasher <br /> Gothes tlrycr Clothes washer <br /> Range hood I Water heater <br /> Exhausl fan Sink(servicelbadmoplelc.) <br /> Heat pump � Backflow prevenler <br /> Unit heater I Urinal <br /> Boiler �rinkin Founlain <br /> Floor drain <br /> Refrigeration Graase lra <br /> Woodstove Roof dreins <br /> Ductin Medical Gas <br /> 01her <br /> SPRINKLER I SUPPRESSION SYSTEM O�her: <br /> Number of Heads Olher: <br /> ...��';/ceiLty lhat I�aw read ontl�_aaminetl Ihia nDPlkalion ond Anmv lho sama lo Go truo and cortecl.All provaions ol law�end ordinances povem�B Nu rype olwork vnA�o mmpRed <br /> :;��i v.hctner spedfieC herMn ot nat.Tho BrantinB ot u peimit does nol pmsuma lo OM1'e auV�ority lo Nclato or cancel Ne p�oNsbn of any oNer state or local L�w reB Wtinp conslruclion <br /> I n�n I.im am�onzeU�y Iha owncr ol lhif pmperty to peMorm tlio�wd lor w�k�aDP�K��b^is maae uuJ I ccnpy wi�I�o Stme Contmclon Ww 1827 RC W nnd 298200A WAC. <br /> ,,.,� - i 2/W/iz <br /> �1��,� r' /�' (RevlseCf✓2o12! <br /> Owncr/Authorized Agent Signalure Date <br />