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� � <br /> PERMIT APPLICATION <br /> BUILDINGIMECHANICALIPLUMBINGISIGN/SPRINKLERIDEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 w�rnro.everetlwa.org <br /> /—GI—/5� <br /> SITEADDRESS: PROPERTYTAXp PERMIT�Q —oO� <br /> �r� ,v <br /> J <br /> LEGAL lor new construclion� Shor1 PlaVsu6tlivision Lol No._ (atlach copy ol tong legal Oescnption) <br /> OWNER I��%Y�S�. PhonelE-mall yZ 3 �P 7 —77 <br /> Atldress � ZZ <br /> ���Y,s��,�,z�p F��+- t,v,�- .2 I <br /> APPLICANT:�[Owner Owner'sAgenl Canlractor CaNraclar's�gent _7enant�r�„ic�a.,a=;,�eccc���+eo,ro.r:=�c+.�����oow�orv�,m�,,�«1 <br /> CONTRACTOR fYl �k 0� Slate Lic. #MA RICS P C c��y e�5. uo. �v SJ� <br /> ndaress PhoneiEma�l �/2rj 3 S $ 3 2 � <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> PhonelE-mad <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of Owlding HEAT SOURCE�. <br /> Proposed Use of Build�ng Gas__ Eiec�nq___ Omer_ <br /> Bmlding lype� _Single Family _Duplex_Townhouse _Multl-Family _Commerual <br /> Type of pro�ect New _Atlddion _Remodel _Repair_T I. _ _Sign_Sprinkler_Demolition,Change o(Use <br /> DESCRIPTION OF WORK �ac,�;�onai space pro��ded on tne band <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type al Projech _New_Addn _AIMra�ion_Repair Type ol Project'. _New_Addn _Alleration_Repair <br /> Show Number(p)oI/ixtares Show Numbcr(p)ol lixtures <br /> A/C—av hantlhng umts Toiiel <br /> � Foicetl air systems � BatMuU _ <br /> j Gas pipin9 I Lavatory(wash basin) <br /> � Wd�er hea�er � Shower <br /> � Gas fireplace � Kitchen smk 8 disposal <br /> � Gas range I Dish�vasher <br /> � Clothes dryer I Clolhes washer <br /> Range hood � Waler heater <br /> Exhausl lan Sink(servicefbar/mop/etc.) <br /> Heat pump � DackOow preventer <br /> Umt healer Urinal <br /> Boiler � Drinking�ountam <br /> � Refngeralion � Floor dram <br /> Nloodstove Grease trap <br /> Duc�ing � Roof drains <br /> � Other Medical Gas <br /> STRINKLER I SUPPRESSION SYSTEM Other e wt e- � � �... <br /> NumberofHeads � Other: <br /> I�ereDy cen�ly�ha�I�ave reatl and examined 1�i5 apOfwlion and know I�e sJmc lo De ime acO co�rect A9 p�ovisions ol laws nnG orEinances goveming t�is lype ol wo�k will Ee mmpSeE <br /> wnn wne�her sDeGfed lleiein or nol t�e granling ol a permd tloes nal D�esume lo give aWM1ouly to violate ar wncel ihe D�onslon ol any olher stale or local taw regulating cons;Nclion <br /> Tnal I am aul�auxetl Ey ihe mrner of Ih�s pmpeny lo petlorm t�e wa�k lor whicn aODLcalion is ma0e anE I comply wil�t�e Slate Comraclo�s law IB 17 RCVJ an0 296100A�h'PC <br /> .�A ��� <br /> Owner/Authorizu gent5ignaturc Datc fRe�iSedJR013) <br />