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l <br /> PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBINGISIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everer, !�'4 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 1 PM <br /> PROPERTYTAIfp P ��T* <br /> SITE ADDR SS:C - D�j <br /> �, 2. <br /> LEGAL lor new conslruction: Short PlaVsubdivision Lal No._ (attach copy ol long legal desctiption) <br /> OWNER � ,,,i � PhonelE-mail p� 3S • oZ -'S <br /> Address (�� � , .. t v ��r2-.J CitYlSlatelZip �.�� �T� ���3 <br /> APPLICANT: Owner _.OwnefsAgent CoMrac�cr ContraclofsAgenl _Tenant(mmipm�ae.ienermw��emmmmav«nsrioaowonmme�p.cel <br /> CONTRACTOR .�,. �A.�l F- - / - L&I Lic.# ZI �. COE Bus.Lic.# <br /> Address y . � 1� �Sf t , h � � i� J� �� PhonelEmeil �/q�p �� a a <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> PhonelE•mail <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK ��_cn <br /> HEAT SOURCE: <br /> Existing Use of Building <br /> Pfoposed Use o(Building Gas Eleclric_ Olher <br /> Building type: _Single Family _Duplex_Townhouse _Multi-Family _Commercial <br /> T e of pro'ect: New Addition Remodel Re air T.I. Si n S rinkier Demolition Chen e of Use <br /> DESCRIPTION OF WORK(additionai spece proviged on tne back): <br /> ��_s! n ti ti�a �,..,�-n L �,t S' � t'.�C/1�.9zG <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of ProJect: _New_Addn _Alteration_Repalr Type of ProJec�� Show NumEer(N)o/fl tutres`lon_Repair <br /> Show Number(M)of flxfures <br /> A/C-air handlin units ; Toilel <br /> Forced air s stems 1 Ba�htub <br /> Gas pipin i Lavato (wash basin) <br /> I� Water heater Shower <br /> Gas fire lace Kitchen sink 8 dis osal <br /> Gas range Dishwasher <br /> Clothes d er Clothes washer <br /> Range hood Water heater <br /> Ezhaust fan I Sink(service/barlmop/etc. <br /> Heat pump BackFlow preventer <br /> Unil heater � Urinal <br /> Boiler � Drinkin Fountain <br /> � Refri eration � Floor drain <br /> Woodstove Grease tra <br /> Ducting I Roof drains <br /> Other Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM � Other. <br /> Number of Heads � Other: <br /> I hereby ce�dy�hal I hnva read anE e.amined this applicalian enC know Ihe sama lo be Irue entl wrtect.Atl Orovisiana W law:end oNinancee Boveming thie type M work wtll De complied <br /> wit�whether specTed hereln or not.7�e grenting al e permil does not Drcsuma to gWe eutnority lo violate or cencel��e provision W any ot�er stale or bcal law repuletinp construdbn <br /> That I am authwizetl by the ovmer ol thla propeny lo pedorm t�e work 1or which eppliwlion b maEe en0 I compty with the Stero Contreclon Lew 1827 RC W enE 296100A WAC. <br /> � Q(� ��� .,s.n�/����-���� ��� � � <br /> �"��`J Dale (Revrsed 6.2012) <br /> OwnarlAuthorized Agent Signat � <br />