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• \� <br /> � PERMIT APPLICATiON <br /> BUILDINGIMECHANICALIPLUMBINGISIGNISPRIt�KLERIDEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Evere;t, WA 98201 -425-257-8810—FAX 425-257-885i—www.everetMra.org <br /> APPLICATIONS ARE ACCEPTED FR061 8 Ah1 TO 4 PPA � ��3�-I� <br /> SITE ADDRESS: PROPEFTY TA%q PLR7�IT� <br /> 3 E. i w iv _p <br /> LEGALIcrstvcons:mction: ShortPlz'Jeutdlvlsion LGINe_ (ettsChccpyo�lor.�le9alde:crip;ion) <br /> OWNER A-Q�rJ �A{NE Fnar.�r.m�ii -�' �'-�3 <br /> :.ddress , �e E l�EwfL�DCrE :�2� cidrs'`erz�p � �LC-T Wi4" ��/.3 <br /> CONTf2l;C70R �/ d-Iv 1 E PLMI - �-{ IL E I Lic,� !J /-I L L <br /> FCtla�s ��p�p f3 . (�. L � /�/ �- 9�Q�J.3'� Phare/Em�i� �{25-775-(oL � . <br /> TENANT BUSINESS NAtv1E CONTACT FOR PERfdIY pp���� 2�{'L�UF� <br /> U�'T / <br /> Phor,c!Ema�! ��j-7� 'J�'�!-��lO <br /> BUILDING PERI111T APPLICATION CONTRACT PRICE OF WORH� �� ,OU <br /> Existing Us=01 Buildirg_ HEAT SOURCE'. I <br /> Proposed Use of Building Gas f�Eie_trlc_ Otber <br /> Buildinglype�. �SingleFamily _Uuplex_To�;mhouse _IAWti-f2mily _Cvmmercial <br /> Typeo!projecl _tJe�v _Addition _Remodel _Repzir_T.I._Sion_Sprinkler_Demolitien Change otUse <br /> • DescriplionofWork(adddionalspaceprov:dedonLheb��k�: �EP[.4� ��SnN� tr� !-'yJe/��� (�(/1T1-r <br /> NP�/ G'fS �u,e,�-�.4�� .T.�/ �.4rn-�. LacA�nar�� �'o �eu) G�s �l��n/�-, <br /> Havcyous;aricd�vodcingeaithoutapermli7 _YES �JO <br /> MECHANICAL PERMIT APPLICATION PWPo7BING PERRIIT APPLICATION I <br /> TypeoiPrnJech ._New AdAn Alterotion_Repair iypeolProject _P;ew_Atldn _Alter.�lion__Repalr <br /> lthav�Numbcr(zJ of/iatures Show Numbcr(.)ol fizt��res <br /> MC-airhandlingun%s � Toilel � <br /> �— � Forcedairsystems � F3atnWb <br /> � Gas pipino � Lavatory(�vash basin) <br /> � 1Nater��ealer � Shov:r <br /> � Gas LreplaCe � 1<itchen sink d di<posal <br /> Gas range � Uish�n�asher <br /> � Clcthesdryer � Clolh�sr�asher <br /> � Range hood � lNafer healer <br /> � Exhawl tan � Sin4(servicelbarlmoplelc) <br /> Hcat pump � �ackllow prevenlcr <br /> � Unit heal=_r � Urinal � <br /> � Boilct � DrinY.ing F'ountein <br /> � R�1riAerelion PloorUrain <br /> � Woodstove � Greasc trap <br /> � Ductina � Rooldralns <br /> Other_ � WedicalGas <br /> SPRINKLEk / SUPPRESSION SYS'fEM I Other: <br /> � Number ol Heads � Other. <br /> I hereby certify tha;I h::ve reztl and examincd inis appl:cation an0 kno.v tl�e ezme to be We 2nd cenecL Ali Frovi'-ions o'lav�s er,d ord�mar,cc;govemino <br /> • ihi;type ai�acrk�dll be compl'�cd vriN r.hether spcafied here:n or rot 7he orrnGng ol a permit does not presume to�rve�uNori,y to viclate a cnce! <br /> the provis�on of eny other stale er loczl law repuWling consWction or Ghe pedortnanc=ct wnSruc6on.That I cm aulhar'¢ed hy Ue m�ner c!Lh��s proper,y <br /> to F ihe v.nrk l�or�s/hicJh aFP���"'� " �made�nd I tomply�/�n}h the Stcte ConVactors Lsw 1627 RCW snd 296200 WAC <br /> !/C� " � - �/�J�� <br /> Owncd thorizedAgenlSign re � ' DaI? (nee'aedf011) <br />