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PERMIT APPLICATION <br /> � BUILDINGIMECHANICALIPE EMBING IR IGNERPIRENKLERIDEMOLITION <br /> CITY OF <br /> 3200 Ced�r St., [verett, VJA 98201 425-257-8810 FAX 425-257-8857 v�nv��.PER 1ettwa.org <br /> aao��T��q p07 <br /> SITE ADDREiS: <br /> Lol I4o.� (����ch ccpy o�long leg�l descriplio�) <br /> LEGAL(or ne�v consuuciwn�. Short PiaVsubdrv�s�on — �^n_ <br /> �L�, �_ PhonelE-mail ��"fVv <br /> OWNER V �- ���- �� ,SNaHorn�srt �.11 R �9d <br /> / CitylStalel7.� <br /> Address Q 3� ` �� � s� <br /> COnifO[IO�SA9enl _T�nanl(���+�o�or�o^a�euerotco�:^-���'�omvao.r.�mar���^����^espace <br /> APPLICANT: _G;:n^_r _Ownei'sFgent �CoNrador '_ <br /> T ��/..} SlateLic. � '/ <br /> Dk'lNz'Pt!-�iu'f cav o�5 u� tt <br /> CONTRACTOR V � TE � phoneiEmail 4/�����o'.�� � <br /> nddress ��j I37[ti . L �Nw�U� CONTACT FOR PERMIT 8�,4y�/ �-�u��� <br /> TENANT BUSINESS NAME I1 <br /> � PhonelE-ma�l ^i������ n � <br /> CONTRFCT PRICE OF NORK ��� ' <br /> BUILDING PERMIT APPLICATION HEi�T SOURCE <br /> Ezisling Use of BuJdmg <br /> Gas_ EiecUlc_ ��ner___ <br /> Proposed Use o�l/Building To���nhouse _MullrFamdy _Commerual <br /> Bwld•ng�YPe- ;L Singie Family _Duplex_ _ � _Sprmkler_Demci�hon_Chang<^ o(Use <br /> Mew Add�Uon Remodel Repa�r __ T I S'9 � � o � 5io� 5�L <br /> •,TyFeofPra�ect ,_ —. . l\EY�2 up � <br /> DESCRIPTION OF WORK(ado�i�onai space prov�deC on me oacal <br /> pLUMBING PERMIT APPL�CATION <br /> MECHANICAL PERMIT APPUCATION A�lcralion_Nep.ir <br /> Alleretion_Repair TYpcolPwjccC _Nnv_�ddn � <br /> Typc ol Project: _N�'y—Addn _ Shaw Number(p)of lirfures <br /> � Todel <br /> Shmv Num6cr(N)of/ixfures Ba���(ub <br /> q/�—air handling units � <br /> � Forczd air syslems � Lavalory (�'+ash basiN <br /> I �i,nip�n� � Shov+er _ <br /> � yyater heater � Kildien sink &disposa� <br /> � Gas(irep���"- � Dish�+�asher <br /> � Gas ran9e I Clothes v+asher <br /> � Clolhesdryer I Wale� healer <br /> � Range hood � Sink(serviceibadmop�etc 1 <br /> � • Eahaust fan �— � 6ackllow preventer <br /> Hcal pump � Urina� <br /> � Unit heater � Drinkinn Founlain <br /> � �odcr � Floor drain <br /> � Refrigerahon � Grease lraP <br /> � Woodslove � Roof drains <br /> � Ductmg —� � Medical Gas <br /> � Other� I Otl�er. �p�-�E� �P � <br /> SPRINKLER I SUPPRESSIUN SYSYEM I Other <br /> I Number ol Heads . <br /> ovxm.ng inis ryVe o�`pO1k`�'��oc compi c <br /> 9 Y mvi5ionofanyaihcrsiTcorloca����•v�egulalingmnslmcban <br /> InacbYcerolylOxllnareieadanCe.�mmedt�rsapp!ica5onandFnowlhesamelobolmeandco�recl AIIPI�vil�Ihe5laleConmtlorsW�v1827RCWantlP962W�N'aC <br /> �.;��,ry�.i+Nher spenGeU�iertm or not T�e g�anhn9 0��D«m'�daes nol p�esume to ve aul�vnt Io vioiate or cancel i�e G <br /> Tnat 1 am aufio�aea Oy me o��.�c�ol��is p�cperly�o petlorm ine�+ork lo��•����'PP�'����on i�made antl�camp y <br /> /�� ���� (ReviseJ 3/10 U) <br /> .-�-- �� �—tDale <br /> Owner ulh zeJ Agen�5�9����°« <br />