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PERMIT APPLICATION <br /> BUILDINGlMECHANICAL/PLUMBING/SIGNlSPRINKLER/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 /> APPLICATIONS ARE ACCEPTED FROM 6 AM TO 4 PM . a S `�I Z <br /> SITE ADDRESS:��i^ O n ! PROVERiY 7A%N PERMIfT���_v� <br /> �S /�! <br /> LEGAL tor new conslruclion� Short PlaVsuhdrvrsion Lot No_ (attach covv ot io�iegai tlescnpuon) <br /> � <br /> OWNER ,Q!'' .�yJ-/ %1 LS%.G �7 PhonelE-mail `� '�.cf�/'Z`�/�l <br /> Adtlress � (� - Ciry/StatrJZiP f' ,t:i � WJn /��� <br /> APPLICANT:_ONner Own^rsAgent �ContraIXor ContraclofsAgent Tenant�m�sipowes�mrdmnsm���o.�erioeo.w�.nmawwc� <br /> CONTRACTOR � � %;�f� L 8 I Lic.#tiu - ' i4 Y. COE Bus. Lic.il d � <br /> Adtlress y�/J �;�� .Q '> PMneJEmail �5"'' �� -yDL <br /> ENANT BU I E S NA E CONTACT FOR PERMIT <br /> 'Sqk�n� n�o�eDs'�'-o7 <br /> PhonGE-mad �/ �-' -�/ � <br /> BUILDING PERMIT APPLICATION CON7RAC7 PRICE OF WORK ,3� 7C0 �� <br /> Existing Use of 6uilding HEAT SOURCE: <br /> Proposed Use of Building Gas E�ectric_ Other_ <br /> Buildingtype: �.SingleFamily _Duplex_Townhouse Multi-Family _Commercial <br /> T of roecC New Addition Remodel Re ir T.I. Si n 5 nnkler Demolition Chan e ofUse <br /> DESCRIPTION OF WORK(additiona�space o��idetl on me ouck): <br /> G/hcE /ni /Gn:4 /-u.eNF7GE �`Jli1/,�� Ou.�" <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> TypoofPro�ect: _New_Addn _Alleration_Repalr TypeafProjttt: _New_Addn _Atteration_Repair <br /> Show Number(pl ol fixtures Show Number(NJ o!firfures <br /> A/C-airhandlin unils Toilet <br /> Forced air s slems Bathtub <br /> Gas pi in Lavato (wash basin) <br /> VValer heater Shower <br /> Gas lireplace Kitchen sink 8 dis osal <br /> Gas ran e Dishwasher <br /> Clothes d er Clothes washer <br /> Ran e hood Water heater <br /> Exhausl fan Sink service/barlmo letc. <br /> Heat pum Backflow preventer <br /> Unit heater Urinal <br /> Boiler Drinkin Fountain <br /> Fefri eration Floordrain <br /> Woodsrove Grease tra <br /> Duclin Roof drains <br /> Olher Medical Gas <br /> SPRINKLER I SUPPRESSION SYSTEM Other: <br /> Number of Heads Other: <br /> I liere�y certAy tlial I have maE an0 ewmmM Nis applratan anE know Na same to ba we antl mrteq.AY pmvisans ol laws anU oitlinances Bovommg�his lype of wo�k wll Go wmpNe�f <br /> vm�.Mel�crspcafwAhemnornot T�ogra^In9olapermilticesnotpmwmalogrvoaW�onlylovrolalowwnrelt�upmvisbnolanyoNerstaiewloralWwmgulatingconstrudron <br /> t�al I am aW�orixM Cy I�o owner ul tlus pmpmly 10 petlorm No xro�k lor whitl�applratan is mada anU I mmpN x���l�e Stale Conlrndors Law 1817 RGW anU 29G.700A WAC. <br /> I <br /> � !/ ���) %y-�`�-�� <br /> i !��- � Revised 620121 <br /> �erlAuthorized Agent Signature Dale � <br /> f <br />