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PERMIT �\PPLICATION <br /> BUILDING/MECHANICALIPLUM�3INGISIGN/SPRINKLER/DEMnLITION <br /> CITY OF E1�ERETT PERMIT SERVICES <br /> 3200 Cedar Si., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br /> -- 3 —/� <br /> £ITEADDRESS: � 0 PROPERTYT p PERMI C <br /> 3 - / C 9 d d �'� �e p -0� <br /> LEGAL lor new conslruction Short PlaUsu6dlvision Lol No.__ (attach copy ol long Icgal descrip;ion) <br /> OWNER Phone/E�mail <br /> Adtlress CitylSlatMZip <br /> APPLICANT:_Owner OwnersAgent Conlractor �CoMractorsAgenl _Trnantlm�s:w�+���aionrroiwmr..iaommaw�ur:aaowcn.�nmoscaml <br /> CONTRAC70R ,�- �d"�' Slate Lic. # �-+ J C . Lic.# <br /> Address �7,s �. R� ` O� 1' �a � one/Email d � <br /> TENANT BUSINESS�IAMe CON79,CT FOff,PE�MITA J� <br /> ./� �\�j [� r....�ljj �D-( <br /> / � � ✓^P� � / Phone/E- ail L V O �� �'j <br /> BUILDING PFPcM1T APPLICATION CONTRACT PRICE OF WORK� G's, C r <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building Gas_ Eiearic__ o�ner__ <br /> 3wltling�ype�. _Singie Family _Duplez,_Townhouse _Mutti-Family �Commercial <br /> Type of projecC New Addition Remodel _Repair_T I._Sign_Sprinkler_Demolition_Change ot Use <br /> DESCRIPTION OF W RK(addhonal space providedon th backl'. <br /> .��v.f� �� d`-✓�r �v c `j �/'Q �� <br /> MIECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Typo ol Project: _New_Addn _Altorallon_Repair Typo of Project: _New_Addn _Altaration_Repair <br /> Show NumAer(M)oI/ixtums Show Number(qJ ol Iinures <br /> A/C—air handliny units I Toilel <br /> I Forced air systems BathNb <br /> Gas piping � Lavatory(wash basin) <br /> Water heater � Shower <br /> Gas freplace I Kitchen sink&d�sposal <br /> � Gas range I Dishwasher <br /> Clothes dryer I Clothes washer _ <br /> Range hood I Water h?ater <br /> Exhaust fan � Sink�service/badmop/etc) <br /> � Hea�pump I �ack`low prevenler <br /> Umt heater � Urinal <br /> ! Boiler Dnnking Founlain <br /> � Refng^ration I Floordrain <br /> Woodslove I Grease lrap � <br /> Duclin � Roof drains <br /> � Other I Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM � Cther / <br /> Numher of Heads � � Olher. <br /> 1 hmeby cenAy t�al 1 nave read anE eaamineC Ihis app:iwhon an0 know ihe same lo Ce Itue and wrretl.All pronsions ol laws ond orCii�nces govCrmnq I�is type ol wo�k wi�l0e comphM <br /> wnh whMher speMmC hemin or not.T�e granlinq ol a permt docs no�Dmsume to grve numonly to violale or cancel Ihe pmvision ol any other slale or lowl law reg�aling wnstmction <br /> Thal I am am�on:eE ey i�e owner ot i�is prepetly io pertorm I�e Mork fo�w�icq app!:w�ion is mntle nntl I ccmpry wnh I�e Siale Comraaon law 18.27 RCW and 29o200A WAC. <br /> � ( � � <br /> Owner horize Ag Ignatum D te !Revised1R0f3) <br />