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PERMIT APPLiCATION <br /> BUILDING/MECHANICALIPLUMBINGISIGNISPRINKLERIDEMOLITION <br /> CITY OF EVERETT PERMIT S�r�VICES <br /> 3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br /> rJ-i3-i <br /> SITE ADDRESS: / �� � � {e �I� PROPERTYTA%N PERMITA , <br /> � ! '7 )C _ i�a. <br /> LEGAL lor new constmction: �hotl PlaVsubdivision Lot No.__ (altach copy ot long legal description) <br /> OWNER , i • �{� M ` Phone/E-mail �J �T U <br /> � Ciry/Statc 'ip L V� <br /> AtlJress �� - -( <br /> AFPLICANT: Ov+ner Owner'sAgent Coniractor Coniraclor'sAgeM _Tenantu-�s��m�meei�imroiw�sem�mmme�.��erueo.oa��mesca-el <br /> CONTRACTJR �� �-'� �� � State Lic.# �'L l-� 7� � L1 Cit Bus. Lic.# <br /> / C' f�-� i �n <br /> Address _'�� ' /}{,Y _y-� �U ) ' � PhonalEmad � � �,� ; " 1 <br /> TtNANT BUSINESS NAME � CONTACT FOR PERMIT <br /> Phcne/6mail vl. - �� n� '� <br /> BUILDING PERMIT APPLICATION CONTRACTPRICE OF WORK '��tX'7 <br /> HEAT SOUi:CE: <br /> Exis�ing Use of 6uilding <br /> Proposed Use oj-Building Gas_ Eledric Other_ <br /> \ <br /> Building type: L Singte Family __ Duplex_Townhouse _Multi-Family _Commercia <br /> T pe of project� iJew _Addilion _Re:nodel _Repair_T.I._Si n_.Sprinkler__Demoftion_Change ol Use <br /> DESCRIPTIONOFWORK(addi,iona�spa providedontheback): �� / <br /> ;;.5/��/''�� ,� /�' ``>� l`f`�/ S' <br /> MECHSINICAL PERMIT APPLIC4TIOf�i PLUMBING PERMIT APPfLl6?11TION <br /> TypaolProjac4 _New_Addn _Alloretlon_Repalr TypeolPraJecl: --Now_Addn _Allorall _Ropalr <br /> Show Num6er(NJ o/lixtwes ow Number(N)ol lixfurc <br /> � NC-air handling unils , Toilet / <br /> I Forced air systems I [3alhtub <br /> � Gas pipin I Lavab. (wash basin) <br /> � Water heater I Sho r <br /> Gas fireplace Ki hen sink&disposal <br /> �, � Gasrange T7shwasher <br /> ' I Cbthes dryer thes washer <br /> ' Range hood / W er heater <br /> Exhaust fan Sin (servicelbar/mopletcJ <br /> Heal pump Back ow prevenler <br /> � Uml heater � �! Urinal <br /> I Boller f Drinkin FouNain <br /> Refrigeration i � I Floor dr -n <br /> �� Woodstove ' Grease lr p <br /> Ducting Roo(drain <br /> � Other I Medical Ga <br /> SPRINKLbR I SU!'PRESSION SYSTEM _ Other. <br /> I Numberof Heads ' Other: <br /> I hereby cenAy Ih�t I ha�e ieod nnd uxam'ned this npplsalion anC know Ihe sama to 6a Ime and certed.all pmvis�ons of laws ontl ordinances goveming t�is type ol woik�a�l Oe compbed <br /> v:,li�ane;ner specnrea hemm cr ncl Tne grantmg ol a pertnA tloes nol p:esume to give aumonty to vo!a'e or cancel ihe pmvnion ef any olher stale or lowl law reAula�ing consWc�ion <br /> n,;n i��n��moraea ay mo owr�/5�o�t�b pmpe edortn the woB for wn�¢li apPbcalan�is matic nr.J I romFly wA�I�e Slate Corlratlors law 10 27 RCVJ anU 29Ci 200A WAC. <br /> N�_— <br /> Own:dAul����t5lgnaturo A Dale (Revi5ed3��0�31 <br />