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PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBINGISIGN/SPRINKLER/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 /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS: PROPERN TAX N PERMIT/ <br /> It3oG - Is�' Av� S� oo� a8oaoo19o0 � �a � ��o� � <br /> LEGAL lor new consiruclion: Short PlaVsubtlivision Lol No._ (aflach copy ol long legal descnp�':�) <br /> OWNER �Q V� �Kl� ,s�h Phone/E-maii y 7.� � � g� 7 4 `� � <br /> Atldress � � �j�b " � V J� CityiStatelZip �/ A 9 g a o g <br /> APPLICANT:_Owner OwnetsAgenl ,}�Contractor ContractorsAgen� Tenant�mus�pc.�aeeanernm�,saninw+�meo«rari000wannu,esoe:e� <br /> CONTRACTOR QQT k. l�'�J�` r�� L 81 Lic.# �I OR� H 34P�f CO[Bus. Lic.# ��1�� <br /> Atldress lq2o� - BA�t.;�GbR WA�' n� tfPv� �S phoneiEmaii�06'36S'�y��I oR-'f�P��� <br /> TENANT BU INESS NAME CONTACT FOR PERMIT �qd{., <br /> PhonME-mail (ti1G�Gfl�7 ` vu��`� <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK��Q_• — <br /> Existing Use of Building Q+��c• HEAT SOURCE: <br /> Proposed Use oF Building �`tV Gas� Elednc_ omer_ <br /> Building type: XSingle Family _Duplex_Townhouse _Mulli-Family _Commercial <br /> T pe u(pro ect New _Addition Remodel Repair T.I. Si n Spnnkler Oemohtion Chan e of Use <br /> DESCRIPTION OF WORK(addinonai spaco pro��dedon me back): <br /> ��StAt,i nbc� GAS Fu�R.oQAc� <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Typa oi Projoct: _Now_Addn Alloration_Rapalr Typo ol Pro�ecl: _New_Addn _Alteratlon_Repair <br /> Shaw Numbcr(M)o/lixturns Show Number(I)ol Crtures <br /> A/C—air hantllin units Toilet <br /> Forced air s sta. is Bathtub <br /> Gas pipin Lavalo (wash basin) <br /> Water ht�ter Shower <br /> Gas fireplace Kitchen sink 8 disposal <br /> Gas ran e Dishwasher <br /> Clothes d er Clothes washer <br /> Ran e hood Water healer <br /> Ezhaust fan Sink(servicelbar/mopletc.) <br /> {ieat pump Backflow preventer <br /> Uml heater Urinal <br /> 8oiler Drinkin Fountain <br /> Refri eration Floor drain <br /> Woodstove Grease trap <br /> Uucting Roof drams <br /> Other Medicai Gas <br /> SPRINKLER I SUPPRESSIOY 5YSTEM Other: <br /> Number of Heads Othec <br /> I�ereby ce�dy t�at I have r_ad e�M e.emmetl IAis opplicaUon end Anow Ihe same lo be bue end cortecl.AI!pmvisions oi laws antl orCinnnces qoveming IN5 type ol�wrk vnll be complred <br /> v.rn wnel�er spcUmC�ercrn or nat ine granLng ol e perme Eces nd presume lo qive aWOany ta vidate o•cancN I�e provislon ol eny ot�er s�ete or bcel�ew repulating canstruclon <br /> 7 nal I am eulno�etl Ey lhe owner ol t�is pmpeny to pedortn t�e work Iw whKh app¢a6on Is metle and I mmNy wi1�Ine State Conlrac]ors Laa i827 NCW and 296200A WAC. <br /> � S�i /D.�y-iz <br /> OwnedAuthorized ABenl Signatu Date (Revised 6�1072) <br />