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�� lllz. o � <br /> PERMIT APPLICATION <br /> BUILDINGIMECHANICAL/PLUMBINGISIGN/SPRINKLERIDEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett,WA 98201 425-257-8810 FAX 425-257-8857 www.everethva.org <br /> ApPLICATi0N5 ARE ACCEPTED FROM 8 AM TO 4 PM <br /> n , � PROPERNTAXp P M� �� � <br /> si ���ss: /�-/l1� �7�v <br /> IEGAL for new wnstruction: Short Plal/subtlivision Lot No._ (altach copy ol long legal tlescnption) <br /> i '� <br /> OWNER ��L�}L �'�i ���p Pnone/6maii <br /> Adtlress Ciry/5ta1c/Zip <br /> APPLICANT: O�vner Owner'sAgen� Contrac�or Caniractor'sAgent TCfIdOI(mustC�o.As�ktkralttmaciLromNam�nen000nehnV.e�p�ce1 <br /> CONTRACTOR�oDiiu����t I'Lcc �K Di�l � L&ILic.N L��D/4P�'}'Z7ZCZCOEBus.Lic.# <br /> Address J y L U� f�G /'f�- �!��i %��"' PhonelEmail �{Z r"�S y—�1�� k <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> �� �1 � ,�/ <br /> ,/�'e! C �2 �� �•L// PhonelE-mail <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK ? � n� <br /> Existing Use of Building HF:AT SOURCE: <br /> Proposed Use of Building Gas_ Eiecmc_ Other_ <br /> Building rype: _Single Family _Doplez_Townhouse _Multi-Family _Commercial <br /> T pe of pro'ecC New Addilion Remodel Repair T.I. Sign Sprinkler Demolition Chan e of Use <br /> DESC RIPTION OF WORK(addmonai space provided on me bacx): <br /> Nt.�� n�Tif ,��;�ry�-, <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Typv of ProJect: ,_New_Addn _Atlerallon_Repalr Typu of Project: _Naw_Adtln _Alteration_Repelr <br /> Show Numbcr(aJ o!flxfures Show Number(NJ ol Ilrfures <br /> AIC–air handling units L Toilet <br /> Forced air s slems � Bathtub <br /> Gas pi in � Lavato (wash basin) <br /> Water heater I Shower <br /> Gas fire lace Kitchen sink&disposal <br /> Gas ran e Dishwasher <br /> Clo�hes d er Clothes washer <br /> Range hood Water healer <br /> � [xhaust fan Sink(servicelbar/moF�etc.) <br /> IHeal pump � Backflow preventer <br /> Unit hcater Urinal <br /> Bo,�� Drinkin FauNain <br /> Refrigeretion I Floordrain <br /> Woodstove Grease trap <br /> � Ductin Roof drains <br /> � Olher "Aedical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM Other: <br /> Number of Heads Other: <br /> �i <br /> I Ocre�y<en:'y lhat I�am rea�antl e�nmined t�if opplicalron and know tho sama to ba Uvo enE eortecL M Frovisiom of W�n end oNnantn govemin';�Ih e typo of woA a+A Ee compced <br /> e;�ni v,nN�cr specif�ea herein ot nol T�a pranOnO ol a permil Uoee nol prmumo to 0�'e eul�oriy to vioWfo or cnncel No pmWsbn ol any oN¢r atale or h�cal law repulalinB�onstmtl�on <br /> m�IlamauNodzedDyNoawneroll�bpmperty� afmt�oworklo�whkhepP�etioniamaCaendlcomprywlht�aSlaloConlractonLew18.37RCWend290iD0A14'AG. <br /> l � <br /> " �����w ,� l'���5 �����' <br /> Ov/ner/Authorized Agenl Signature —�Dale (Revised N20f21 <br />