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PERMIT APPLICATION <br /> BUILDING/MECHANICALIPLUMBINGISIGNISPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br /> 1 � �-/ <br /> SITE ADORESS: VROPERTV TAX k P� O _ �,c� <br /> �'I�D� L�'ACc�-J n�E (�CJ <br /> LEGAI for new construclion� Short PlaUsubdrv;s�on Lol No._ (atiach copy ol long legal desuiption) <br /> OWNEFtyL��S� AVI 7`r Phone/E-ma�l � 2�- d�"fo— �3 <br /> r,daress Si}.+�� City/Stale2ip �✓i.�1x�7— Ws� <br /> APPLICANT: Owner _pwner'SAgenl _Con�ret�or ConlracloYSAgenl TCnanl�mcuoron�oaieeero'coosem�mmUeo+-nermpowuan��eswcel <br /> CONTRACTOR �-� i>(t-oo I'i.5 �(�� Slate lic. # aRoo K �r'��/J� City Bus. Lic. u <br /> Aytlress Sz�Ci N� �� C/2�-� ��.1\yV /�D Phone/Ema�l �2.�OKs � �.1�.✓1��� D!2-�i- <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> �Jzf-F 'b��S�S � <br /> Phone/E•mail 20�•�00- If�i � <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK � "i � �o� <br /> Eaistmg Use of Buddmg R.�*S �J �Tl^�- Sllf(s1.���Ll`� HEAT SOURCE: <br /> Proposed Use o(Builtling SA'�E 5 L�f2 Gas [icctr¢ Other <br /> Budding type�. ✓Sinqle Family _Duplex_Townhouse _M11ulti-Family _Commercial <br /> Type of pro�ect New Adddion Remodel Repair ✓ TJ. _Sign_Sprinkler Demolitwn Change of Use <br /> DESCRIPTION OF WORK jadd�honai space provrded on me back�: f rg b NI�d��Q <br /> T�-''hn— �c�wN 41C� � l..✓�U-S �o� ��'�'ilR�.,.H � Rl-��v�� � .n.� wo�IIS � <br /> f <br /> �19H`t ��o j�M..�i . l�S�n.� (t`C�C1-fny' �.....t)/l-11onJ � �L A�S � <br /> MECHANICAL PERMIT APPLICATION PIUMBING PERMIT APPLICATION <br /> Typo of Pro)ect: _New_Addn _Alterallon_Repair Type ol Project: _New_Addn _Alteration_Repair <br /> Show Number(N)o/Hxfures Show Number(p)ol lixfurns <br /> A/C-av handling umis '� Todet <br /> forced air systems ✓ f3athlub <br /> Gas p�pmo � Lavatory(wash basin) <br /> VJater heater ✓ Shower <br /> Gas freplace � Kdchen sink 8 tlisposal <br /> I Gas rang� Dishwasher <br /> Clothes dryer ; Clothes washer <br /> Range hood � Waler heater <br /> `� [ahaust lan <br /> I Sink�serv�ce/badmop'etc.) <br /> � Hcatpump � BackOowpreventer <br /> � Untl heater � Urinal <br /> ' OOAer I Drmkmg Founlain <br /> ; Relrigeration Floor dram <br /> � Woodstove � Grease trap <br /> Uucting Roof drains <br /> Other I Medical Gas <br /> SPRINKLER ! SUPPRESSION SYSTEM ! O�hei <br /> Number of Heads I Othec <br /> I�ereEy ceNfy Ihat I�ave reaE entl eRam:ned Ihis apd-anon an7lnow the snme to be Irve antl mrmd FII pmnsions ol laws 0��ordmances goveming Ihis type ol woA x+A Oe compie0 <br /> vnl�whether s0ecd¢G herein or nol.T�e granfmg a1 a pertn�Eoes nol presume to give evlhorily to vioiale or ranul lhe piovismn ol any olher sla�e or towl law�egaial'rnp coniWqion <br /> That I nm au��on:M GY Ue owner ol lhis prcpeny to perlortn tne woA lor which appiaation is ma0e anE I comply wn�Ihe Sie�e Comredors Law 1B 27 RCW anE 196 200q WAC. <br /> 9. �9 ,� 3 <br /> � � z <br /> O a /AuthorizodAgentSignature Dale (RevisedY2Gt3) <br />