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PERMIT APPLICATION <br /> BUILDINGIMECHANICALlPLUMBINGISIGW/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar SI., Everett,WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM J `.� —�� <br /> SITE ADDRESS: M PROPERTY 7a�c p PERMIT N <br /> (s��J� /'IG22� 1,L, C��I�. Z OY02 �3a I Uo � �-- <br /> LEGAL for new mnslruction� Shon PlaVsubdnision Lot No._ (altach copy ot lon9 Icgal descnDGon) <br /> OWNER (� PhonelE�mail <br /> Address j(�\, CirylState2ip C�/`f„{U+ �.t� �j�� <br /> APPLICANT; Q�ner OMnefSAgc�tl �Conlratlor Con�r,�cloYSAgcn1 _Tenan��m,mom�a.o�reA�+�+em�emo�+.�+roao.�+..no.cawl <br /> CONTRqCTOR �S 1 � IeGV 1AN7 Clt, L 81 Lit.# n'lU C COE Bus.Lic.# <br /> nderess $��, 5 22Z.ND ,�_ A�BUJI PhonelEmail '1+0(e-.Sf$- 75�. <br /> TENANT Bl1SINESS NAME CONTACT FOR PERMIT '�D K�sTcn.n'�N <br /> ZOD lA �, 1"•�li�W.m,7W PhonelE-mal µ/�O' 7 5- 52 <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK �� CD 66 <br /> E:isting Use of Bwlding HEAT SOURCE: <br /> Pmposed Use of BuJding Gas_ EiecMc__ Other_ <br /> Building rype: _Single Family _Duplex_Townhouse _Multi•Family _Commercial <br /> T pe of pro ecl. New Adtldion Remodel Repair_7.1. Sign_Sprinkler_Demolilion ' Chan c ol Use <br /> DESCRIPTION OF WORK laed�nonai space pm�ieed on the bacti!. ' <br /> � Wsv'Ac,�, 2 Nu..� 6tiwr�+4S , L S1�1KS' �•�, l NCcJ Ux�t.� �'�ec.�'. <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type ol ProjecC _New_Addn _Alteration_Repair Type ol Pmject _New_Addn _Alterafion_Repair <br /> Show NumDer(A)o!firfums Show NumDcr(pl o/laYures <br /> NC–air handling units Toilet <br /> Foru!a air s sfems Bathtub <br /> Gas pipin Lavito (wash basin) <br /> Water heater Showcr <br /> Gas fireplace Kilchen sink 8 dis osal <br /> Gas ran e Dis�washer <br /> CIOI�es a er Clothes w35her <br /> Ran e hood Wate�healer <br /> Exhaust fan Smk(semcelbar/mo letc.) <br /> Hcat um oaanow reventer <br /> Unit heater Urinal <br /> Boiler Dnnking Founlain <br /> Reingenlion Floor drain <br /> Wootlstove Grease trap <br /> �uding Roof tlrains <br /> Other Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM O�her. <br /> Numher ol Heads Other: <br /> I hem�y cerory Itiat I have rcatl anC e`amne0 Nu apP�G�b^nnC Fnaw Me same lo�e true anE cortttY.N1 provrnam al Wvs anG otdnances poveminp Nls rype ol wod vn0�e comp4ed <br /> wit�wlwNer speufieJ herem or npt.ilw B���UnB ol a pnm�Gces nol presume lo prve auNonry lo vblate m e�ncel tlie pmvisron ol any oNe�slate or local law repuW4np wns W cUon <br /> That I am aut�omeE Ey I�c owne�ol Nrs pmpcM b pertortn Ne aoA lor whirli ap0�����it maae and I wmpN�^��e 541tc Coniradon Law 1827 RC1Y nn0 79fi 200A WAC. <br /> ����.��- r2- �s-r z <br /> OwnedAu ori:cA Agen[Sign ure Oate (Revised 6R0111 <br />