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i <br /> PERMIT APPLICATION <br /> BUILDING/MECNANICAUPLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES (� -�a9''��— <br /> 3200 Gedar St., Everett, WA 98207 425-257-8810 FAX 425-257-8857 www.evereltwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITEADDRESS: PROPERTYTAXN P �T� _n <br /> � <br /> LEGAL lor new wnstiuction: Shorl PlaVsubdivislan Lot No._, (aUach copy af long legal Eesuipllon) <br /> OWNER PhonelE-mail n•��" ��� � <br /> Address �� � Y�'��' CilYl5latelZip <br /> APPLICANT:_Owner OwnefsAgent �Conlrector ContractofsAgenl _Tenentcm�npa.aa.�enermca�um�nu+eo»�oxioao..«kmm.w.ca) <br /> CONTRACTOR � L&I Lic.# ���E LJ �- /7�K COE Bus. Lic.# <br /> Address )� � �(,' I N /,(,' PhonelEmail .� ' _30 �- DD <br /> TE ANT BU INESS NAME CONTACT FOR PERMIT <br /> ua5 �03- ��� <br /> PhoneiE-meil <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Ezisting Use of Building /�,,,4,n�i�lv �'t!'O � HEAT SOURCE: j <br /> Proposed Use of Building,�ol�,(.f�Pin�'.� Gas Eiectric other <br /> Bui�ding type: �Single Family _Duplez_Townhouse _Multi-Family _Commercial <br /> T e of ra'ect: New Addition Remodel Re air T.I. Si n S rinkler Demolition Chan e af Use <br /> DESCRIPTION OF WORK(eddifionel space provided on the back): <br /> ,�p�/✓ �� _'>���,� c%�zd, /t� L.a,c_e, <br /> , <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> TypeofPtoJect: _Naw_Addn _Alteralion_Repair TypeofProJect: _New_Addn _Allaratlon_Rep�lr <br /> Show Number(M)ol flxturea Show NumDer(M)olllrturea <br /> A/C—airhandlin units I Toilet <br /> Forced air s slems I Bathtub <br /> � Gas ipi� I Lavato (wash basin) <br /> I Water healer Shower <br /> Gas freplace Kilchen sink 8 dis osal <br /> Gas ran e Dishwasher <br /> Clolhes d er Clothes washer <br /> ood Water heater <br /> Ezhaust fan I Sink senice/barlmo letc. <br /> Heat ump Backflow reventer <br /> Unit heater Urinal <br /> Boiler Drinkin Fountain <br /> � Refri eralion I Floor drain <br /> Woodstove _ Grease lra <br /> Ductin I Roof drains <br /> Other Medicai Gas <br /> SPRINKLER/ SUPPRESSION SYSTEM I Other: <br /> Number of Heads � Other: <br /> I hereEy ceMy Ihal I have rcatl end ezeminetl Ihis epplication end knor.lhe eame lo De Irue and corrM.All Drovisbns al tawa and ordinenm�pweming thi�rype W xrod wiA Ea mmpFed <br /> wM�wTether spec�otl hereln or not.7�e granting of e perm�l doen nat pmsume to pNe eut�oMy to violate a unxl the provbbn d any ot�er�Me a bul law repuietinp cansWtlbn <br /> Thal I am aut�orized Ey��e armer ol tMs pmpe�y m peAorm Ihe wark br which apDlicatbn b made antl I comD�Y��Na Stete Canhecton L�w 7817 RCW�nE 398 200A WAC. <br /> OwnarlAuthorized Agent Sign�ture Date (Ravised 6R0f2) <br />