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PERMIT APPLICATION <br /> BUILDINGIMECHANICALIPLUMBINGISIGNISPRINKLER/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 /> SITEADDRESS: PROPERiY p p PERMIT# <br /> Y1 . �e ����� Z20� - � <br /> LEGAL lor new consuuclion. Short PlaUsubaivision l.ot No._ �attacn copy ol long legal descnplion) <br /> OWNER � PnonelE�mail ' 1�S—� � 1S �y rj � <br /> Pddmss S'gY-i. Cay/5tate�7.ip <br /> APPLICANT: Owner Owner'sAgeni Coniraclor ConlractoYsAgenl __Tenanti���s�r•o��caaieu�rmccosc�irmmuoc.�oraao+.on,�meswcei <br /> � � State Lic # � �� Cuy �us lic. # $ � <br /> CONTRACTOR ) Con CtiC <br /> Address 1 w � ,(� � Phone/Ema�l �^S��"S7S� <br /> TENANTBUSINESSNAME CONTACTFORPERMIT {.��_(��1� 9SS� <br /> Je��,,�t <br /> Phone/Email � Con o , �9. . <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK m � � <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of/�uilding Gas_ ._ Eieqnc _. __ Otner_ <br /> Building rype: _y(_S�ngle Famdy _Duplex_Townhouse _Multi-Family _Commerual <br /> Type ol projecC New _Addition �Remodel __,_Repair_T.I._Sign_Sprin�ler_Demotitioq_Chanre of Use <br /> DESCRIPTION OF WORK(adtl�ncna�spaceeroviCedont�ePack): (� (� <br /> � ��pl� ce �ex��^5 <t�t c1.�Qc� , R���� I s,� e �7 c��i o� �»,s•-e <br /> 'MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type ol Projec�: _New_Addn yyAlteration_Repair Typo ol Project: _New_Addn _Alteration_Repair <br /> Show Numbcr(P)o/�ixfures Show Numbcr l�)a���xfarcs <br /> A!C-air hand6ng unils ! Toilet <br /> � Forced air systems I Bathtub <br /> Gas piping I Lavatory(�vash bas�n) <br /> � Waier heater I Showcr <br /> � Gas fireplace I Kitchen sink 3 disposal <br /> Gas iange Dish��vasher <br /> � Clolhes dryer � Clothes washer <br /> Range hood � Water heater <br /> Exhausl(an Smk(service/badmop/elc) <br /> Heat pump � Backflow preventer <br /> Unit healer Urinal <br /> Boiler � Drinhing Foun�am <br /> j ReG�gzration I Floordrain <br /> Woodsrove Grease Irap <br /> Ducung I Roof drains <br /> Other Mediwl Gas <br /> SPRINKLER / SUPPRESSION SYSTEM Other <br /> Number of Heads � Other: <br /> I�creoy cetl.ly Ihat I�ave reaC and eeammeG I�rs app4:�licn antl Anow t�e same lo Ee Ime anE cottecl.All pmvuions ol laws Entl ot0�nance,govem�ng l�is lype al woM1.x+ll Ce complied <br /> xitn wnelner speoliea nerein ar not.Tne granting al a penNt tices nat eresume t0 grve aulnotity lo v�oiate or Canccl ine provis�on ol any olner sta:e ar laal lan regula'ang conswnion <br /> Tna�I am autnenzeE ny i�e oxner ol�his property to perlorm I�e acrk far w�iN appikahon is maEe and I compty wrh Ine Sla:e CmtraCars law 78 27 RCW anE 29G100A WAC. `( <br /> I� <br /> J I l-��-I'� <br /> � <br /> O / Ihorized Agent Signalure Dale (Fevise032073) <br /> u <br />