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� • <br /> PERMIT APPL►CATION <br /> BUILDING/MECHANICALIPLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY QF EVERETT PERMtT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 425-257-88t0 FAX 425-257-8857 www.everettwa.org <br /> SITEADDRESS: � / � PROPERTYTA%tl PE liN <br /> p�¢jO f trt � � '�'��"0 g <br /> LEGAI for new conslruclian: Shorl PlaVsubdivision Lcl No._ (altach copy ol�ong legal descnplion) <br /> OWNER �K�C t7r K . 0 f IS )C!�/. Phone/E•mail ��j � — ���� <br /> AOtlress � ;(tTff City/Slale/Zip I � � <br /> APPLICANT: Owner Owner'sAgenl �CoNraclor Conirador'sAyenl Tenant��.,sipm:ceueveewmmeninwnmea.Mr�aaowo�a���easwcq <br /> CONTRACTOR ' {L�v� Slate Lic.# � City Bus. Lic.#�.3�15�� <br /> Adaress 3 � 5 � G, PhonelEmail a — <br /> TENANT BUSINESS NAME CONTACT OR PERMIT 'r <br /> �fQfCC,E �ON1Wh�^.{� `�/lt�t PhonelE-mal�..n.0..1 R'i.1�fe <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK � � <br /> � <br /> Existing Use oF Building ` "� HEAT SOURCE: <br /> Proposed Use of Building NONQ Gas_ Eieclriq Other_ <br /> Building lype� _Single Family _Duplex_Townhouse _Multi�Family xCommercial <br /> v <br /> Type ol pro�ecl New _Addition Remodel _P.epair_T.I _S�gn_Spiinkler Demoldion Change of Use <br /> DESCRIPTION OF WORK�advmona�space pro.iaed on me oack): <br /> e o,�p<<�� �,.�.o i,d��i� e-� 131�� -�- , <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _Naw_Addn _Alleratton_Repair Type al Project: _New_Addn Alleratlan_Repafr <br /> Show Num6er(p)ol Iirtures Show Number(x�oI firfures <br /> A/C—air handling units I Toitet <br /> � Forced air systems Bathtub <br /> � Gas piping � Lava�ory p•�ash basin) � <br /> � Water healer Shawar <br /> � Gas fireplace � Kitchen sink 8 disposal <br /> � Gas�ange Dishwasher <br /> � Clolhes dryer � Clothes washer <br /> � Range hood Waler heater <br /> � Exhausl(an Sirk(service/badmopfelc.) <br /> Heal pump Backflow preventer <br /> � Unit healer � Urinal <br /> � Boiler � Drinking Fountain <br /> Re(rigeration Floor drain <br /> Woodstove Grease�rap <br /> Dutling � Root drains <br /> Other � Medicai Gas <br /> SPRINKLER/ SUPPRESSION SYSYEM I Olher: <br /> NumberofHeads � Other: <br /> I nereby cMAy I�al I hare read antl examine010is applkation and know Ihe samc lo be Irve and cormU.Ail piovisionz ol laws and oralnances gwerning Ihis P�pe ol work w!I be complled <br /> d�w�e�her specifie0�ereino�noL T�e granling ola Derm�l Coes ncl{'�asume lo giae aut�ority lo violaie or cancel t�e provisian ol any ol�er slale ar local law regulzling cnnsVuclion <br /> t I am am�ori:etl owner ol ihis pmpeny ia pMortn t�e wark fo��Mic�aDD�Kalion is maEe an01 comply wil�I�e Slale Conlradas Lam IB27 RCW anE 196 200A:VAC `� <br /> Z <br /> � •✓� / <br /> O Authorized genl5lgnalure Tle (Revised3R01?) <br />