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PERMIT APPLICATION <br /> BUILDING/MEC HANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, W� 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org , <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM a `—g <br /> SITEADDRESS: � PROPERNTA%p PERMIT� ,/ <br /> 36z5 /'uCr_�� /� ✓z /'/ '� " c, <br /> LEGAL lor new mnsiruction: S�otl Platlsu6division _Lol No.__ (aUach copy al long legal tlescbplion) <br /> OWNER e L��-er <br /> L (J+1 !L Phone/E�mail y2{ 328 G �,� �' <br /> ntldress ,3 `l�`( �7� � ��C- r.�ryBtate2iv <—v��eTT �-�/!¢ 9 � 'v / <br /> APPLICANT:_Oxner OwneisAgent �Coniredor _Comractor'sAgent _Tenanl�m�s�em.a•okixroic�mmir.omme�.-roaownnmupace7 <br /> CONTRACTOR 5�""`f �t�`hF�;`•;( 5�'%"{idnS L81Lic.# 3"G �VJ~fS �Szk'�OEBuS.Lic.# <br /> Adtlress <br /> �a��y �n/Plt �� �jn�c�`^'fj�i �✓� Phone�Email 71S �3�'� �/ .i v <br /> TENANT BUSINESS NAME GONTACT FOR PERMIT r `�� �� <br /> L R'✓'�[/•�r" �3 aJ-�Z�-.3� <br /> � /�hj/� J�-�3C� PhonGE�mail /�s3� <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK .'��"' '� — <br /> HEAT SOURCE: <br /> Ezisting Use of Buiiding <br /> proposed Use of 8uilding Gas_ Eiectnc_ Olher_ <br /> BuildinglyFe: _SingleFamily _Duplez_Townhouse _Multi-Family �Commercial <br /> Type of project: New _Addition _,Remodel _Repait T.I._Sign Sprinkler Oemolition Chan e of Use <br /> DESCRIPTION OF WORK(sdddional space provided on the back): <br /> w ��� �„� c(,..}� <br /> �•�J �=�:O: ,a� �O �0..�r' /I L' � <br /> MECHANICAL PERMIT APPLICAT�ON PLUMBING PERMIT APPLICATION <br /> TypeofProjec4 _New_Adtln _Allcration_Repair 7ypcofProJecL _New_Adda _Altcratlon_Repalr <br /> Show Numbcr(k)o!tixlures Show Numbcr(N)ol lUtures <br /> NC—airhandlingunits � Todet _ <br /> Forced a�r systems I 6alhtub <br /> Gas pipin Lavato (�v�sh basiN <br /> Waler heater � Shower <br /> Gas freplace Kitchen sink 8 tlisposal <br /> -� G2s iange Dishwasher <br /> Cloihes dryer Clolhes washer <br /> Range hood Water heater <br /> � C-xhaust fan Sink(servicelbarlmop/etc.) <br /> � Heat pump Backtlow preventer <br /> � Umt heater Urinal <br /> � Bod r �rinkin Pountain <br /> Refrigeration � Floordrain <br /> Woodstove Grease trap <br /> � Ouctin Roof drains <br /> � Olher Medical Gas <br /> SPRINKLER I SUPPRESSION SYSTEM Other: <br /> Number ol Heads Other: <br /> I here�y�c�tty Ihal I havu rentl onU eRemmed ll�is uVPlKubon ana Anmv iho somo lo�a Imu an0 cortecl.A!I pmvisiom ol Wwf ond oNnoncea govemng Ule rype o�wod ml�e cnmplied <br /> m:li r.�ic�lmr speufm0lieieln ot not.Tho grnnlin9 0l a pemct daef nc�pmsumo lo B�e oul�only In�iolale Or cnncel��o proNsron ol any a��er staln or lowl hw regulaliip canSVucLon <br /> i i�.:n 1 am nu�noiiaed Oy�he mvncr olThh pmpeM�o pe�orm the wak lor whk�nppfKatbn i�ma�o and 1 mmpH�hh I�e 5'nlo Commclors Lmv 10 21 ftC W and 29fi 200A WAC, <br /> / <br /> -:Z �/� /� 3 <br /> � OwnedAuthotlmd A9ent Si9nature <br /> Ua1e (Pevised 670tt1 <br />