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� � <br /> PERMIT A6�P'LICA�ION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 �Nww.everetlwa.org <br /> SITEADDRESS: � � PNOPERiYTAMp P� MIT �( <br /> �0 ( ft VV• <br /> LEGAL for new conslmcliant ShaA PlaVsubtlivision Lo�No._ (altach copy of lang legal descnplion) <br /> OWNER ���� 7l� (�C . 0 f �SQ 7�C! Phone/E-mail �G - �- 33SD <br /> ACdress � ,(��fF Gty/Slate2ip I � Q <br /> AFPUCANi: Owner Owner'sAgenl �Conlraclor Contractor'sngenl 7enantim,nv9�a�0i�n•�d�o�,�muomm.a.o..�000woni,we�.�.� <br /> CONTRACTOR ' -IG�l.1 Stale Lic.# �k c��r s�5. ���.np,f55�0 <br /> AdEress 3 � � , .�rG, C �•o• Phone/Email a — — <br /> TENANT BUSINE55 NAME CONTACT OR PERMIT <br /> � L / `�� �o/�� ,,..:a�. �,.�k.+e <br /> �'lC�C (.OLN�^'���^� t � phone/E-mail <br /> BUILDING PERMIT APPLICATION CONiRACT PRICE OF WORK <br /> g N6� � <br /> Exisling Use of Buildin �"� ti�p HEAT SOURCE: <br /> Proposed Use of Building�P.�P Gaz__ Elecvic_.__ o�her <br /> Bwlding lype: _Single Family _Duplex_Townhouse _Multi�Famity }�Commercial <br /> c� <br /> Type ol pro�ed�. New Adtlilion Remodel _Repair_T I _Si n_Sprinkler Demoution_Change ol Use <br /> DESCRIPTIONOF�K(addd'on1 spaceprooe�nmeoacw/ ` , <br /> J ���:��c�w�,�;�k�.�tf <br /> e�,�pi<��, „�.01,�( �0� ��� I <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> 7ypeofPrajecl: _New_Addn _Alteralion_Repair TypeofProJecl; _New_Addn _Alleralion_Repair <br /> Show Number(pJ o//ixfures Shew Numbei(pJ o/lixfures <br /> A/C—airhandlingunils I Toilel <br /> � Forced air systems Bathtub <br /> Gas piping � Lavalo (wash basin) <br /> � Waterheaier Shower <br /> � Gas fireplace � Kitchen sink 8 disposal <br /> � Gas range � Dishwasher <br /> � Clothes dryci � Clolhes washer <br /> � Range hood Water healer <br /> Exhaust fan Sink(service/barlmop/elc.) <br /> Heat pum � 0ackflow preventer <br /> � Unil heater � Urinai <br /> � Boiler Drinking Founfain <br /> Refrigeretion � Flnordrain <br /> � Woodslove Grease Irap <br /> Ducting Roof drains <br /> Other Medical Gas <br /> SPRINKLER/SUPPRESSION SY5Ti EM other: <br /> Num6er of Heads � Othei: <br /> I nereby ceroly I�al I heve reatl and ewami�ed Ihis appl!calion and know Ihe same lo Ce Ime and cmrctl.All provisions ol laws and arCinancez gaverning I�is Iype o/work w�p bc mmpFed <br /> ih w�elher specifmG hmein or noL The graming ol a permil aacs nol presume Io give aulhoriiY la vioale or cancci Ihe pwvision oi any olher slate ar local law requlalin9 canslrvction <br /> t I am au�horized Gavmtt ol iAis pmFeAy io pMorm��e work IorxTlc�aDFlicailm is made anC�comply vnih t�e Slale CoMraclors law IE37 RCW aM 796 200A WAC. <br /> \ / <br /> ( �� <br /> / <br /> O . nlhnrizad onnl5ionature ale (Revised7/20f3) <br />