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♦ <br /> PERMIT APPLICATION <br /> BUILDINGIMECHANICALIPLUMBINGISIGN/SPRINKLER/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 8 AM TO 4 PM <br /> SITEADDRESS: PROPERiYTAXp PF�R IT• -�,� <br /> 3 �i5 Si�o..� v,°. Goti' 7a(��GOco3�'G I <br /> LEGAL lor new conslruclion: Short PlaVsubdivision Lot No._ (attach copy of Iong legal description) <br /> OWN=_R �•tw.•�^ < < L. J��v>/rn� <br /> �cv Tr,.:•� Phone/6mail HzY'aY^'IoJI <br /> t.ddress L`131 Vjewcrc>�` -4vc,. ;�. City/StatelZip G✓Prrlt�wJ{ �9S°Z�3 <br /> APPLICANT:LOwner OwnefsAgeni Conlractor Canlraclor'sAgeni _Tenanllm�siv�o.+eeeie�erctwnsern*ommac+,nen>ao.o��nmesva:cl <br /> CONTRACTOR �wi �f e.s/+ Cen�'(��ucf�0 L81Lic.# COEBus.Lic.# <br /> B~{ �l', M (G: t e �'� 9 $�Ys Phone�Email 4�s- 3k$'- 3z83 <br /> Address � Zf . <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Phone/E-n+ail <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> HEATSOURCE: <br /> Existing Use of Building <br /> Proposed Use of Building Gas_ Electnc_ Other_ <br /> Building type: _Single Family _Duplex_Townhouse _Multi-Family _Commercial <br /> T pe o(pro'ect: New _Addition Remodel Repair_T.I. Sign Sprinkler_Demolition_Chan e o(Use <br /> DESCRIPTIONOFWORK(edd�tiona�spacoprovidedontheback): �j2 ��� <br /> ,(1��- b.�u�� . NcS'�' <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Typo of Projoct: _Naw_Addn _Alteratlon_Repair 7ypu of Projoct: _New_Addn _Altoratlon_Ropair <br /> Show Number�k)o!lixmres Show Number(q)o//ixfurcs <br /> A/C-au handling unils i '. Toiiet <br /> j i forced air systems 3 : BathWb <br /> Gas piping t � Lavatary(wash basin) <br /> � Water healer Z I Shower <br /> � Gas fireplace I I Kitchen sink&dispcsal <br /> � Gas range � I Dishwasher <br /> � Clothes dryer Clothes washer <br /> j Range hood -� '���"— <br /> Exhaust fan I Sink(service/badmop/etc.) <br /> Heat pump I Backflow preventer <br /> � Umt healer I Urinal <br /> I �oiler I Drinking Fountain <br /> J j Re(rigeration I Floor drain <br /> �� Woodstove ! Grease lrap <br /> Ducting y � Roof drains <br /> � Other j Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM Other. <br /> Number of Heads �_ Othec <br /> I hereCy cenAy thal I�aw reaE anE eaamined Ihis aDP�'�ation entl know ihe same to�e trve and mrred.All pmvisions ol�ara anC ortl'�nances 9oveming this type ot xrork will be compliea <br /> with xTefher speci�ed hereln or nol.T�e groming ol a pertnit does nol presume to give autnortty to violate or wnu I tne provisn�n ol any ot�er state or lowl law re8ula:ing consiruclion <br /> TTat I am authorizeE by t�e ownet ol iMs pmperty to petlortn t�e wo�k Io�v.Tich appliwtion Is maEe and 1 comply wM1h Ihe Slate�onlractan Law 18.27 RCW anC 296 200A N'AC. �I <br /> 1 / <br /> Y�— <br /> ,( ./.tc.i�L ����72 <br /> Ownor/AulhorizcA A9ent Signaturc Date f��'evised 6R077) <br />