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�ERMIT APPLICATIO� <br /> BUILDINGIMECHANICALIPLUMBING/SIGNISPRINKLERIDEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www everettwa.org / <br /> G-iS-�� <br /> SITE ADDRESS: PRovEaTY rnx p P a T a <br /> .�r� �v�.��� - -012 <br /> LEGAL lor new conslrucUorc Shor1 PlaUsubdrvis�oi�_ Lot Nu_ (al�ach coDy ol long�egal 4e5aipLonj <br /> UWNER `�(.� d� Phone/E-mail ��� �i'3> / '�/' / <br /> /�� I <br /> Aadtess y 7 � /vlF'j"ZG��2 C�tylState/Zio v _ � L.�� � � <br /> APPLICANT: Owner _O�ymersAgenl ___Cont�acm� ___Contracior'sAgenl _Tenam.m�siv��•��e+n•.���am��se^i��nrm��-.�nao,=,�,,me+c��dl <br /> CONTRACTOR State lic # City Bus. L-��c it <br /> Ph;ne�EmdJ <br /> FQ�tC15 <br /> CONTACT FOR PERMIT <br /> Pnone�E�mail �'�� '— � �I -� ��� <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Eristing Use ol8wldina _ H[AT SOURCE� <br /> ProGosed USe of�uild�ng_ Gas_ He[Inc_ Olher__ <br /> 6widing type. _Single Family _Duplex_Townhouse _MuIG�Fam�ly _Commercial <br /> Type cf pro�ect Netio _ __Adtl:tion _ Remodei _Repav__T I __ Sign _Spnnkler_Demolit�on_Change of Use <br /> LIESCRI PTI ON OF W O R K I a��honai space prnvieeo on me eacii <br /> �,�-�, ���-��-- / I I��i ��,-f-��o,-, -� �,�a►�� <br /> / J <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type ot Pro�ecC _Now_Addn _Altcration_Repair Typc ot ProjecC _New__Addn _Almration_Repair <br /> Sbow Numbcr(M)o!l�xtures Show Number(N)ol lirfums <br /> NC-air handhng un�ts Tc�'�et <br /> Forcetl au systcros �athtub <br /> Gas pio�ng Lavato�'(�t'�sh bas�n) <br /> Water healer Shower <br /> G�s frtrp�acc Kdchen smk 3 disposal _ <br /> Ga;ranyc �islnvashcr _ <br /> GloRics drycr Clcthr.s washer <br /> Range hood 'Natcr healer <br /> Exhaust lan Sink (serviceNadrnopletcJ <br /> Heal pump E3ackflow preventer Unside�Idg) <br /> Umt he�ter Urinal <br /> [3oiler Dnnking PaunWin <br /> Retr�gerauon Fioor dram <br /> Woodslove Grease trap <br /> � Dutting Rool tlrains <br /> Other � Mediwl Gas <br /> SPRINKLER I SUPPRESSION SYSTEM Other � / � - {^ <br /> N�im6er of Heads Olher. <br /> i nerc�r cemry m�i i na��i��aa a�a e�minetl Ims appuuLon.nd Anow Ine same lo�e Imr und conect All p�ovivons el Isw,an0 c�Cinanoes govemmg Inis IyFe ol wo0,w^,II Ou com0l:ed <br /> ��tn wnet�u s�euGed he� in or nM The giamn9 v�a permn tices not prcsvme Io gne act�oNy to vrolale or cancrl lne p�mvs�on at any oIDe�stale or bcal law ie9ulalin�wnslmctmn <br /> Tt:al I am duthoni Y� 'o'��cr D�o �y�0 7cdOrtn L�c anA lo�wPrth aDF��U��iO^�s matlr and I ramply vr.t�t�c Stafe CenVaCors la.v 1B i1 RCW an�29G��JA N:1C. <br /> / ,�l/ <br /> OwnedAut ionzed Agent Sfgnaturc <br /> Dale (Revlsed 4R075) <br />