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PERMIT APPLICATION <br /> ; SUILDING/MECHANICALIPLUMBINGISIGNISPRINKLERIDEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everetl, WA 98201 425-257-8810 FAX 425-257-8857 wv.vd.everetN✓a.org <br /> APPLICA�IONS ARE ACCEP?ED FROM 8 AM TO 4 PM <br /> PROPERTYTA%u P MITY <br /> SITE ADDRESS: . �? � .i n.L 'OOS <br /> i J /L _`� <br /> LEGAL for new constmction� Short PlaUsubCrv�sion LOI No_ (attach coPY ol long Iegal Oescnption) <br /> OWNER `�' � � �� �5�..'� � r .� � Phone/E-mail i -ZS � '�� z � � � / <br /> fWdress ? � �- �'�> G� �c: �"`i'r.. c i 1 Cv?3.c� CM1Y/State/Zip L-��!'� <br /> APPLICANT:,y�vwner Owner's�gent Contractor ConiraclorsAgent _Tenanl;m���oro.m�ei�e�ro�co�:rnnomi�����oaa�+����w.:e� <br /> CONTRACTOR / _ L 8 I Lic.# COE Bus.lic.N <br /> Address vV I 1l,// PhonelEmaA <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> / 4 L�, 1 3 z I E'r I — � <br /> , �. �..f r�, % ' ,�.� [�i.S�i �•7 ���•-•y j /�i,r�c C:.- Pnone/E-mail 1� ^ C_� '1 r-� o-�q:i- e �.�-1 <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK Z <br /> EzistingUseofBuiltlng � � -�� � � - ���.� { HEATSOURC[: <br /> Propnsed Use ol F3uildiig c��� c � � - ,�� °-,"� � (� �o�-< C= Gas_ Giecmc_ Omer__ <br /> Building type: 1...-3Gcle Family _Duplex_Townhouse Multi-Family _Commercial <br /> T pe of pro ecC New ddition Remodel Re air T.I. Si n S rinkler Demolition Chan e of Use <br /> OESCRIPTIONOF'NORK(aaainonaispacepmviaedontneoack): /{ ��` ,7� �n � � �/y-t� + <br /> S / .� �r � � . z X �1{ l.� c-c d Y , U T <br /> I � (C C...� '�Iti <t�C�� � \ y i (�� 1 �wl E� <br /> �� 1 � �,���. , ,_s <br /> � ,�.%�� 1��. c ti c� `,f� !�: t�.:'� E- �!Y c�� L• ��t <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Prajecl: _New_Addn _Altera�ion_Repair Type of Projecl: _New_Addn _A��eratian_Repair <br /> Show Number(p)o!fiYlures Shaw Numbcr(0)o(lixfures <br /> AIC-au hantllin uNts � Toilet <br /> � Forced air s stems . Bathtvb <br /> '� Gas pipin \I Lavato (wash basin) <br /> Waterheater i Shower <br /> � Gas fireplace � Kitchen sink 8 dis osal <br /> Gas�.ran e ' Dishwasher <br /> � Clo�lies d er Cbthes washer <br /> Ran ewood ' Water heater <br /> Gxhausttan � ',.Sink�service/badmo lelc.) <br /> Heat um�.. � Backfior+preventer <br /> Unil heater � Ul�nal <br /> �� iler \ D�§�Kin Fountain <br /> Bo <br /> Refri eration ' Floo drain <br /> � Woodstove \ Greasatra <br /> Ouctin Roof drain5 <br /> Other ' Medical Gas <br /> SPRINKL[R / SUPPRESSION SYSTEM Other. <br /> Number of Heads Other. <br /> 1 ticreby cetl�ly��al l have maE anA e�amineA t��s appMcalron an0 Anow the same to be Uue and corted.All pmvisions el laws a�a oN�nances goveming I�is lype olworA w�ll be wm0��e4 <br /> � wn�whelher spealird herein or not The Aia^Lcg ol a pertntl Coes nol pmsume to grve aut�onty'o valate oi fancel tM pmvisw�ol any ot�er stae or iowi law rcgWabng conswr.tmn <br /> Tl�al l am authonreG by I�e owner ol tnispmperty�o perfortn O�e wo`k lor wh�¢h a0p��calron is maae anE I campk w+��Ihe Slale Comraclors Law 1B 17 RC\'J ane 296 200A\NAC. <br /> 1 <br /> / _ C��/ <br /> 1�� / � D�e (RevisedN10f21 <br /> Owncr/AuthorizcAAgentSignalurc �/ I <br /> i <br />