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, � � <br /> PERMIT APPLICATIO <br /> BUILDING/MECHANICALIPLUMBINGISIGNISPRINKLERIDEMOLITIOIV <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br /> _ab-i <br /> SITE ADDR��0 / �G� O Y� ✓ � PROPERN TAX N P T tt _ <br /> 6 <br /> LEGAL for nc�v construction� Short PlaUsuhtlrvision Lol No (attach copy of long legal desa�ption) <br /> OWNER —� C ��l � �eh 0 PhonelE�mail <br /> Address 3 3 0 � � ND � 0 � !/�'� Cityl5talMZip � V�.�G�` ' w ,v {��O � <br /> APPLICANT: Owner OwneisAgenl �onlraclor Coniractor'sAgent _Tenanllm��vo�o��a��itne�oiu�.,�mrorineo+.��e.ueo»=n��'.nespa:o) <br /> , � State Llc. # C��0 64P 3l- a'��1 Gty Bus. Lic u O k <br /> CONTRACTOR Cx'l� �Jc� I I H'I � � _ <br /> aaa�e55 � 0 '3� s 3�-a— ;r, �'o � a�� ano�e�em�d a-v 6 '.3 6 ' a� Ud <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> PhoneiE�ma�i <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK��' t�'"U <br /> Ezisting Use of Bwltling HEAT SOURCE� <br /> Proposed Use of Build�ng Gas__ Eiectric_ Oiner_ <br /> Bwidmg type ��ngle Famdy _Duplex_Townhouse _Multi•Family _Commerc�al <br /> Type of aro�ect Nev+ __Addrtion _Remotlel _Repav_T.l. ___Sign__Sprinkier_Demolltion_Change of Use <br /> DESCRIPTIONOFWORK�add�r�ona�spacep�ocideao�rneback) _ <br /> R e� � �c ('o I �1 d- ?-�01- W �,�'�- �� 0' � <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type ot Prajecl: _New_Adtln _Alleralion_Repair Type ol Project: _New_AAdn _Alteration_Repair <br /> Show Numbcr(N1 0//ixtures Show Numbrr(a)o/lixtures <br /> A/C-air handhng un�ls Toilel <br /> Foiced a.r systems � Bathtub <br /> � Gas piping Lavalory(wash basin) <br /> Water healer j Sho�ver <br /> Gas(ireplace � Kitchen sink 3 disposal <br /> Gasran9e DiSh«asher <br /> � Cloihes dryer ) Clo�hes washer <br /> Range hood Watei healer <br /> Exhaust fan Sink(servicelbadmop/etc.) <br /> Healpump Backflow prevenler <br /> Unit heater Urinal <br /> Boiler I Drinking Founlam <br /> Refngeration I Floar drain <br /> Woodslove Grease trap <br /> OucGng � Roofdrans <br /> Oiher Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM Othec <br /> ':�m6erofHeadS � � � Other: , <br /> i�ercDy cm]y inal I�ave mad antl eaamined t�is applcatmn antl hnow t�e mme io be tme antl correU Ail pmvisions al laws nnd ortlinanres govemmg t0is IyDe ol wo�k wA!Oe cemp.^tl <br /> wnh whemer sCecAieC�ereln or not T�e 9raneng ol a perm�l Uoes not presume to g���e avi��nty to v�ola�e ar canrel Ihe D����von ol any oiner stale or bcal iaw re9ameng conslmtlmn <br /> Tnal I am aWhorizetl Oy Ihc awncr ol IN5 pmperly to pedorm IM Hork lor wh¢b app:.wtion is m�CC 2ntl 1<Omply wil�I�e$I�te ConuaClars Law 18 27 RCW��tl 29fi 200A WAC. <br /> -�-- ' �� I / �� <br /> OwnedAuthorized Agent Signalurc e (Revised 3�ZO13) <br />