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PERMIT APPLICATION <br /> BUILDINGIMECHANICALIPLUMBING/S[GNISPRINKLERIDEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar Si., Everett, WA 98201 425-257-8810 (=AX 425-257-8857 vn^�nv.everel;wa.org <br /> - �--� <br /> SITE ADDRESS: '��yI O . I ��v� A v . rROPIRiv Tn%p PEqj.11T1 �o k n�3 <br /> I I V t-� 7 <br /> LEGAL for new eonsimtl�on Shod PiaJ;ubd�,vl>ion_ _ l��No_ (�����h coDY of long�ega�desCnF�lon) <br /> OWNER �EQ� ��O L�-� PhonNE�ma�l �ZS^' Z �� ^ � r2p <br /> Address 3 N�u /�a 2j ON V• CiIYIStateR�p L �L�r�^� w/� 7 t�l'O( <br /> APPLICANT: Owner Or:ncYsAgent V omradm CoNracicisPgmt Tewnt!-��up�c.�=��i•�����'�o��.��r.�����er,�<rioeo.:a.m�:n.��.� <br /> CONTRACTOR ��CF ( ��{LS �j- ✓/) Sta,e Lic. d.�.'�J rG-3°`J�'l J � City Bus Lic. it U u�o 5 Z� <br /> Address �06 S �v�� -r- QV� N£ /C.t`�N, l✓n Pnonc�Ema�l �f�-��/�� � P�-✓�Q• 02 Cr <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Pnonc/6ma1 <br /> BUILDING PERMCT APPLICATION CONTRACT PRICE OF WORK <br /> [x sting Use of Bwldmg �'S�`�S '�� � _ HF1�T SOURCE� �_ <br /> Preposed Use ot Budd�ng Gas_ eieur�c_ _ othcr__ <br /> Bwlding iype�. _Single Family _Uuplex_Tcwnhou:e _h'uiti•Fam�iy _Commercial <br /> lype ol pic�ed New _ArC�tion __Remodel ✓Repa�r _ T I __ S�on__Spnnkler _Demoht�on _Chang^ of Use <br /> DESCRIPTION OF/-WORK�•�a,;�on.nspaceCrovmeaon�^e eacw/. <br /> j f.112 o FI' O�-� I I n� S I/4' �-L �J�l.� 20 J r S/t'��l.l-�S <br /> MECHAt�FICAL PEf:MIT APPLICA710N PLUMBING PERMIT APPLICATION <br /> 7yae ol Project: _New_Addn _Altcialion_Repair Typc ol ProJecl: _New_Addn ,_Allcratian_Repair <br /> Shmv NumAa(a)ol firNrrs Show Nambcr�Y)o/firfares <br /> NC-air ha�dGnq unds Toilet <br /> � Forced air systems � Ualhtub <br /> � Gas piping � Lavatory pvash basin� <br /> � Walerheater � Sho�cer <br /> ; Gas f�eplace _ Kdchen sink 8 di,posal <br /> � Gas rangc ___ Distiwasher <br /> � Clothes Aryer _ � Cinthes washer <br /> " � Ran9c hood � Walcr healer <br /> Lxhausl fan SinF;(servicelbarlmop/etc) <br /> - � Neat pump Uackliow prevenler <br /> � Umt hcater Unnal <br /> � Dodcr � Drinking Founlain . <br /> — � RefCgeration � Floordrain <br /> � Woouslove Greasc trap <br /> � Ducting � Ruof drains <br /> � Olher _ Mediwl Gas <br /> SPRINKLERlSUPPRESSI! SYSTEM � Uther <br /> Vumber of Heads � Othec _ <br /> 1 i��rt7y cemfy t�al I have icad and e.amineE tA�s a➢C��r.Won and Anow Ihe same lo he Ime and wuccl.All pwvis�ons ol laws and ardmances goveming�his Ippe ol xark w:l�e mm;'.cd <br /> er,•�n M n:Iher epenficE�erein at no1 Tnc qian'in9 nl�prrmA lars ncl Dmsum^1�9Ne aulAmity to viola�e a�w:fcel V��^wvnion o�any oL1cr slate or laal law iequlaling mm�rvnioo <br /> 7nat I am aV.nmizeA Dy Ihc ownn ol lhis pwpc�'io D���ortn Ne woik lor w4'mh appllcalion is made and I compiy wit�Inc SITc Comraclon law I B 21 ftCtV and 796 200A ta'AC <br /> � __� �-• 2L • �y <br /> �,��e (Fevised 3/1013J <br /> On n rlAuthorized Agcnt Siynciurc -- <br />