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PERMIT APPLICATION <br /> BUILDINGIMECHANICALIPLUMBING/SIGN/SPRINKLERIDEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., [verelt, WA 98201 425-257-8810 FAX 425-257-8857 wv✓�v.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM r-� <br /> SITE ADDRESS: 2�U•� �1��,� �V` PROPLRiY TA%W �[�� ` O / <br /> J \ � <br /> LEGALfornewconstruc�io¢ ShortPiaVsubdivision <br /> Lol No._ (allaUi eopy of long legal desaiption) <br /> OWNER N`z�^ i 1 C11`T'� Phone/C�mail �2`7` Z 5`� '�JS�y <br /> Address �jlU � ��A��l�` 'nU� City/Sta,e/7.iP �U�kLT� V✓A '1 ����Ul <br /> APPLICANT:_Ovmer _Ov:ner'sA9enl �CONractor _Confraclor's�gent _Tenanth��:ip�oY�d-ai�ne�oiw�:�mtr�nmo��:.�•����m.w�xwm�s�accl <br /> CONTRACTOR GUCKGRG�v STaTE s��T ~�' L&I Lia# EVE�CsSS OZ,2oT COE t3us.Lic.# 00 <br /> naa«ss 2l1/� QACIGtt- aUL.EVE tJA 96201 ���o�A��ma�� �Zj 252 -911V <br /> TENANT�USINESS NAME CONTACT FOR PERMIT '�t i��� (���,,,° <br /> ti 1 Phonel[-mail yz '- 25 -� 114 /"�1�''��(u�' SI'•IW�Ik <br /> }��_I- � f C�i�"Ty <br /> BUILDING PERMIT APPL[CATION coNrRAci PRICE oF Wori ' � <br /> Existing Use of 6uilding 5`�� �'1�' ''����� � �'"�2' _ HEAT SOURCE: <br /> Proposed Use of Buitding �""`�� Gas� F_IeCric_ Oiher_ <br /> �uildinglype: _SingleFamity _Duplex_To�vnhouse _Mulli-Family �Commercial <br /> T e o( ro'ect: New Addition Remodel � Repair T.I. Si n S rinkler Demolition Chan e of Use <br /> DESC RI PTION OF W ORK Wdd�trona�space pmvlded on the back): � <br /> cc� � �T I���'/= W iTrl Vi�nl� "��'�' �'�., �-I �'" a�i"` <br /> �(�L�'l�acc C1:u4i ir �- F 2 l,N' <br /> ���tiV ON 5i4� i5 ItiSiiJt ���i�i)iN� rJcT a'� nI�OCG <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Typeof ProjecL• _New_Addn _Alteratimi w. Repalr Typeof Projecl: _New_Addn _Alteralion_Repair <br /> Shmv Nuni6er(d1 0/lixfures Shmv Number(C)a!/ixfures <br /> NC—air handling units Toilet <br /> � Porced air s stems Oalhlub <br /> Gas pipin9 � Lavalo (wash basin) <br /> Wafer heater I <br /> Sho�ver <br /> Gas tireplace Kitchen sink 8 disposal <br /> � Gas range � Uishwasher <br /> � Clolhes d �er Clothes r�asher <br /> R�n9e hood Weter heater <br /> � [xhausl fan Sink(serviceNadmopletc.) <br /> Heat pum� f3ackflow preventer <br /> Unit heafer <br /> Urinal <br /> Ooiler � Drinking Founlain <br /> Refrigeration Piaor drain <br /> � Woodstove Grease Irap <br /> Root drains <br /> Ducting I <br /> � O�hcr_ Idedical Gas <br /> SPRINKLER 1 SUPPRESSION SYSTEM o�her. <br /> I Numberof Heads Othec <br /> I hereby cetlify Ih:A I Imvo ientl nnJ oaaminntl Ihis appPcalion arJ Anrnv Ihe same lo Ue Iruo and wneci.All pmvislons of lervs nnd ordin��ces qoveiring R��s 1 Jpo ol woik will be mmpllod <br /> wilh whclher spcciGeJ herala or noi.l lm g�anl:np o7 a pannl Aoes nol pmsum^_lo�IvO��ithaiily Io vioiato ot wncrl the piovislon ol o�y o�her slotu or local U�,v re5ulatinp eonalmeUon <br /> lhal I am aullioiized by lhe cr:nrr�I ihis propeity to pertonn Ihe v:o�k Ienvhich appfnlion i,maele and I conp!y v:ICi Ihe 5'aic CenLadors tar�1917 ftCCJ artl 23u200A l':AC. <br /> ��� �� � �� �� � � � � (Revised&2012J <br /> OwnedAUlhorimd�9enl5ic�natum � � Date <br />