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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 vrv,nv.everettwa org <br /> SITE ADDRESS: � PROPERTV TA%n PERm1T t _ ��1f^ <br /> �[/ <br /> LEGAL lor nc.v ecosbuclmn� ShoR PlaVsu6Crvision Lol No (����ch eopy o�long Icgal CescripUcn) <br /> OWNER �Q�1Q ��rQ�-' r'�,(�G��W�^^ n PhonciE�m.�l 3qq-337N/ �2 (�,�1P0 <br /> pdaress L �L OG.� Ci�YlSta1C/ZiP 1—f,� (il <br /> APPUCANT:xCwner O�Yn2Y5Ageni _ Conlidcior _CC���aclofSA�Cnt _Ten3nlim�sip,coaeaie'�:aotcoo;erartommaw.n:ueco»:.M�-�^�+:�:N <br /> CONTRACTOR Vl�`r Stafe Lic. # Cdy Bus Lic ? <br /> Aatlr�S: <br /> PhcrelEmail <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> P��arcl[�maJ <br /> F3UILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> [r��5i�ng Use of Huil9�.ng_ , HEAT SOURCG <br /> Pro�osed Use o(Bwltlinp Gas__ EiecmcJ�_ omer_ <br /> BwlC�ng type �Single Fam�iy _Duplea _Townhouse _M11WtrFam�ly _Commerc�al <br /> Type of prolect � New Add�tion Remodel _ Repa�r__T I __S�gn___SpnnY.ler,Demohtion_ Change of Use <br /> DESCRIPTION OF WORK laac r:enai soa:�e c�c�idea on me:ack) <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> TypoolProjec4 �Now__Addn _Alleralion_Rupair TypealProject: _New_Addn _Alteration_Repair <br /> Sl�o•.v Num6ci(aJ o1 h+Nres Show Numncr(a)of f�xN�es <br /> A�C-av I:antlling unds To�'ct <br /> � Forecd air systems Baihtub <br /> Gas piping I I.avatory(�•+�ash basin) <br /> 'i Water heater Shower <br /> Gas freplace � Kdchen smk&d�sposal <br /> � Gas iangc Dishwasher <br /> Clolhes drycr j Clothes washer <br /> Ran9c hood I Water heater <br /> Fxhaust lan S�nk (serv�[ei6arimop/elc) <br /> lieat pump � Oackllow preventer <br /> Und healer Unnal <br /> i t3o�ier Urmkmg Fountam <br /> � Refnge�abon Ploor drain <br /> Woodstovc Grease liap <br /> Ouct�ng Roof drains <br /> � Other_ � Medlwl Gas <br /> SPRINKLER I SUPPRESSION SYSTEM � Otner <br /> Number of Heads I Other. <br /> Iherebyttn.!ytn011naveread.ndMammeetrGappl.WbJnanaYnewlnosamotoOetNeanCcorred Allprov�sionso11aw5P�dcrCr.dncesgove'nm9t�islypeolworkwllCecompbe0 <br /> wdn nc�l0cr sv«'��eE nercm o�nol Tno g�anUng ol a permA Ooes ncl pre;ume lo give aWnonty to vloldle or W r:cl tpe proeiLOn e�any olffer slaio at I�W�law regulat:ng conslNcbon <br /> Thal I am aumonmE Oy tOc owner ol Inis D�eCerty ia DeRctm I�e wark lo�wit�N appi�valion ts matlo ao0 i mmply w�m Ro Sintc Contractors Law 1B 2]RCW antl 256 7�0�WAC. <br /> ��.��.,<,.,�-.__ ��I�l'��3 <br /> 6wner/AuUionzrd Agonl SignaWrc Date (Fev�sed 3:'UI_1 <br />