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PERMIT APPLICATIGN <br /> BUILDINGIMECHANICALIPLUMBING/SIGN/SPRINKLER/D�MOLITION <br /> CITY OF EVERETT PERMIT SERVICES � �S —I 3 <br /> 3200 Ced�r SL, Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM 7 �D r�. — � <br /> SITEADDRESS: 1��•� PROPERNTA%p P RMITM <br /> 1�.- <br /> LEGAL lor new consiruclion�. Short Plal/su�aivision__ Lot No._ (attach copy ol long legal tlesc�ption) <br /> OWNER � '� l.C-ll� � Phone/E•mail Q <br /> dtlress G� T Ciry/Slate/Zip � C�cL / 20 <br /> APPLICANT:_Owner 6�vnefsAgent Conlractor _Contractor'sAgent _Tenant(m�.iv��•eene�o�co�.�mr.omn.�R�oaa..on�m•�c+nl <br /> CONTRACTOH �v�+ l� Y�S l 1 � L&1 Lic.f! �I� �COE us.Lic.# <br /> AtlAress �,Q y 1�� C. •�lCr�-� P�one.'Emai ZO(O 3a.r " I / !d <br /> TENANT BUSINES NAME CONTACT FOR PERMIT / <br /> �j��j K S U/2�{� C�/v r�� phone/E�mail � SC �ULA1� \Z�L _O 'T� <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK 1S� 0�G — <br /> ExislingUseolBuilding � �/.�L'f� �� HEATSOURCE: <br /> Proposed Use of BUilding � P. � Gas Eleclnc__ Ot�er__ <br /> Buildinglype: _Sin3leFamily _Duplex_Townhouse _Multi-Family �,Commercial <br /> T pe ol pra'ect: New Addition Remodel Repair T.L Si n Sprinkler Demolition Chan e of Us: <br /> DESCRIPTION OF WORK(aanit�ona�space proviaenon�ne back): ADD l 1/�� s��'r�� � O�J£ F.n�E/�`�' <br /> LC� I..�fl51-{ .��Ji��� fl-) A'f'i/2-S��^f-t�,l Tp ^�'}}�2�� �1u.-^ �1J���Ev�S <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> TypcolProJecF. _New_Atltln _Altcratimi_Repalr 7ypeolPmlccL• _New_AdAn _Atlerallon_Repalr <br /> Slrow Numbcr(p)o/fixtures Shaw Numbw(p)o!llxlurcs <br /> FVC—airhandlingunits I Toilel <br /> Forced air s stems I Bathiub <br /> Gas pipin Lava�o (wash basin) <br /> Waler healer Shower <br /> Gas fireplace Kitchen sink 8 disposal <br /> Gas ran e I Uishwaaher <br /> Cblhes dp�er Clothes washer <br /> Ran e hood � Waler heater <br /> Eahaust fan Sink(service/badmopletc.) <br /> Heat pump BackOow preventer <br /> Unit heater I Urinal <br /> Boiler Drinkin Founlain <br /> Fefrigeralion I Floordrain <br /> Woodslove Grease lrap <br /> Ductin Roof drains <br /> Other � Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM I Other: ,v� � <br /> NumberofHeads � Other: <br /> 1 hereby cenny mal I�avn rea�und e.aminM��is appltaiion ond know Ihe smne��be�me anJ co�ecl An prcvis�ons ol bae an0 ortlmancef goveming tnie Irye c1�wM�Nt�e comp4etl <br /> wnh v.ncNer spculied lie�ein ur not.Tha gronlin0 0l a pe(m Com nol pmsume tu 9�ve nurt•.:.�.ry to e��o'nle or canccl lhe proNsan ol nny ot�er s�ate or lowl�w rc0�����'^B�o^5�^���ion <br /> IOoI I am eul otli oy m�o.�ne f pmpeM�o peRortn �o work lo�whkli aGP�iwltin ie maae aC 1 comFN������e$Iolo Con!rac�ors law 1B 2T RCW and 2961WA WAC. <br /> � I <br /> � <br /> Owne Au�h i M Sl9nalurc <br /> Oate (Revised 6/.Ott) <br />