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, � <br /> PERMIT APPLICATION <br /> BUILDINGlIVIECHANIC�►UPLUMBiNGISIGNISPRINKLERIDEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar SL, Everett,WA�6201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br /> f�jU"} r(tot��C- ��y11{� APPLICATIONSAREACCEPTEDFROMBAMTU4PM 2 �Z-� _' <br /> SITEADDRESS: -'�i 'ROPERiYTAI(M�}375�,t20e�,3,p7 P MITK^ _O <br /> 7 , rp ./� , I'j0 oc�y37�i "IdG'(71aU1 �� <br /> - �— _ <br /> Lol No._ (attach copy of lony legal desc.nption) <br /> LEGAL�or new wnswctios ShoK RaUsubdivisioq -- � <br /> OWNER ���Ill V i I I CL 'c--' �'�� ' Phonc/E-mail HZ�) —"�O� '�0��� <br /> AdCress �Q• IJZ �'/Z�I City/51ate/Zip ���(C�ll �v`=�V�� <br /> APPLICANT�. O.vner O.mer'sAgent Contrector ConlractorsAgent �Tenant�m�sipo.weaanamca�se+�i�peow�a�oeown�nmewacel <br /> CONTRACTOR ! •�• D' O�� UII�.l1�t- L b I Lic.�l COE 9us.Lia p <br /> ACdress Phone�Email <br /> BU IN SNAM , CONTACTFORPERMIT���nf� �,.(��2 <br /> ��. �a'e��'�'H� C�l�n iC ,SP�nE 1���5�2n� Il� �S'23 -�4y � � <br /> cno�e�e-me�i J�rt�'-('��f��'�f�rS' C�m <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK � <br /> Ezisting Use of Building I nI i� lt !I p, <br /> u? HEAT SOURCE: <br /> PropoSedUseofBuildirg/�'IL'C�/('QI� �nIIIIG�IJ((���:�=1 Gas Eiectric Other <br /> Buildingtype: _Sin9leFamily _Uuplex_Townhouse _Multi-Family �Commercial <br /> T pe o( ro'ecl: New Addition Remodel Repair T.I. Si n Sprinkler Dertwlition Chan e of Use <br /> DESCRIPTION OF WORK/addilional spaca p�ovwedon the backJ: <br /> 5e� s��llnclu�r� <br /> MECNANICAL r`ERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of ProJect: _Naw_Addn _Alteratlon_Rapalr Typo ol Pro�ect: _Naw_Addn _Alteration_Repalr <br /> Show Number(It)ol fla'tures Show Number(N o/flxtores <br /> !JC—airhandlin units Toilet <br /> Forced air s slems I Balhlub <br /> Gas i in I Lavato (wash basin <br /> Water healer I Shower <br /> � Gas freplace Kitchen sink 8 disposal <br /> Gas ran e Dishwasher <br /> Clolhes d er Clothes washer <br /> Ran e hood � Waler heater <br /> � Eahausl fan I Smk servicelbadmo lelc. <br /> Neat pump I Backflow prevenler <br /> Unit healer Urinal <br /> 8oiler Drinkin Fountain <br /> Reiri eration Floor drain <br /> Woodstove Grease tra <br /> I Ductin Roof drains <br /> � Other_ _ � Medical Gas <br /> SPRINKLER I SUPPRESEION SYSTEM otner: <br /> Number ot Heads Other: <br /> �herpby cerlAy t�at I havn read antl eaamr.e[I lhis apd��b�and krrow Me same lo be hun anU co�ecl.M Vrov6qM ol lar5 anE pdi�nces goveming Ihrs lype olwork will6e comp�eC <br /> w1h whether specdied herem or nol.ihe B�anle�g o�e pertn�tices nol presume�o Bhe aulhoriy to vMale or caMel Ihe pmv'sbn ol any oiher state or bcal Ww regulaU�g��sVucio^ <br /> ?hal I am eulhorlieJ�y Ihe owric*ol Mb propMy to peAorm Ine work�or wfrkh apphcatan s ma0e enO�compN����Siate COMractors Lew iB27 RCW aM 296200/WAC. <br /> I I '?� ' � <br /> ��� �1 11 � �� � ����� �t('� � � �Re,asea s�so,z� `� <br /> Own�FlAuthodzed Agent Slgnatura �/,y .{.� \ <br /> i Date <br /> ., �.���.����7��r•���� �'� � �1 � <br />