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. � � <br /> PERMIT APPLICATION <br /> BUILDING/MECHANICALlPLUMBING/SIGN/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 /> SITE ADDRESS: PROPEHTV TN(p PERMIT/ <br /> G 2 czd AJ�. SE �lr�p�.Z( GI - <br /> LEGAL lor new construclion: Shorl PlaVsuOtlivisio�n.¢J�+2��`�l� [�-� Lot No.S (altacn copy of long tegal tlescnption) <br /> OWNER��i�� ACaF �C. y1AC�'c-S Phone�E•mail �Z. 953- Zg�o <br /> 12o SW IicJ�LE,C'T �Aw 4A � � ��• C�� � <br /> Address J • 1 00 CitylSlale/Zip 2� <br /> APPLICANT: Owner Owner'sAgenl CoNractor Conlractar'sAgent 7enant�m�siwo�aaiena�oi�a�mw„ineowo��meo.onmme�p:�� <br /> CONTRACTORS�ATR�. P'��F' �C VM�-S SlateLic.f�rQaOOS6V Cil Bus. Lic.t(pQ�- � <br /> AaCress s�VV�� P�onelEmail S�VH�L. . � <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT ���,�j C��p.L <br /> Phone�E•mail �42�\ 350- 4�Z <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Exisling Use of Building_ HEAT SOURCE: <br /> Proposed Use of Building Gas� Electric_ Olner_ <br /> Building type: ✓ngle Family _Duplex_Townhouse _Multi•Family _Commercial <br /> Type of project: �New Addition Remodel _Repair_TJ._Sign_Sprinkler_Demolition Chan e of Use <br /> DESCRIPTION OF WORK(addrtronalspaceprov�dedonrneback): Z S �. �e ��_q�, <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Typa of ProJecl: _Now_Addn _Altentlon_Rep�ir Typa ot Project: _Naw_AdOn _Alleratlon_Repair <br /> Show Number(M)ol lixtures Show Number(N�ol lixfures <br /> ..� A/C-airhandlin units Toilet <br /> \ Forcetl air syslems Z Balhtub <br /> Gas piping Lavatory wash 6asin) <br /> � Water heater Z Shower <br /> � Gas frepiace Kitchen sink&disposal <br /> Gas range � Dishwasher <br /> \ Clothes dryer Clothes washer <br /> � Range hcod er <br /> Exhaust fan � Sink(servicelbarlmop/etc.) <br /> .� Heat pump � BackOow preventer <br /> ^ Unit heater Uri�al <br /> Boiler — Drinking Founlain <br /> Refrigeration Floor drain <br /> Woodslove Grease irap <br /> Dudmg Roof drains 0 V" <br /> Other --� Medical Gas - <br /> SPRINKLER I SUPPRESSION SYSTEM Other: <br /> Number of Heads Olher: <br /> I�ercby ceNry I�al I have�eaE and e�amined Inis appliwlion anE know I�e same to De Irue anC wrten.All provisions ol laws antl oMinances goveming I�is lype ol woA��nll De compl2E <br /> wA�wlumer sp Rea rei or not Tne groming ol a permn tloes no�presume logive eW�onlyto vioiale orwncel lne pmvision ol any olner slate or bcal law regulalinq consimclion <br /> The�1 am e ��a eC 0 ner oi I�is property lo De�ortn 1�e wak Iofwlik�apD�Kelion 15 R�90e Bn01 CamON��h I�e$Iaie COnlraUols lew IC27 RCW anC 196.200A WAC. �� <br /> L, <br /> 3��3- t 4 <br /> Own r ulhor(zedAgentSignalura Oate (Revised3/ZO1J) <br />