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I <br /> . PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLERIDEMOLITION <br /> C;TY OF EVE�ETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425•257-8857 w�rr,v.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �j�-� �`� <br /> SITEADDRE � � PROPERT' A7(p P RMI <br /> U -O <br /> LEGAL fcr new ccnstn:rnon� Snort°IaVsubCivisicn lot No_ (attac�wpy of long legal descnpl�on) <br /> OWNER PhonelE-mad <br /> AdCress GrylStatrJ2ip <br /> APPLICANT: Orv�er Own¢(5.4gent �CCnVdCO� Contrac;orsAgent TEfL]ni�musto9r�ae�aveictconem�na�unor.amco.c+�nme�mco� <br /> CONTRACTOR L 8 I Lic.tt Bus. Lic. <br /> Atldresst'Q,`C70k���y \`�\���Q V�,11""��'ld�� P�onelEm �0�1 �-h�9��y 4 <br /> TENANT BUSINESS NAME . CONT� T F,.QR P\ MJT ,\ <br /> ���Q. �Q�.. ����� Ib� phonelE•mai al ��J� —��Z� <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Bwlding_ Gas EienncQ omer_ <br /> Building type: _Single Famtly _Duplex_Townhouse Multi-Family �Commercial <br /> T pe o(pro�ect: New Adtli6on Remodel Repair�T.I._Sign__Sprinkler Cemolilion Chan e of Use <br /> DESCRIPTIONOFWORK�add�hena�spacepra�medentr,eback) � <br /> �ercar� ��.�ver�a-�- -��.s�oQ.�jr��o,v�-�Or�- <br /> �o.\-e,� °� �rs-aca\\.r� 1. �>.,J v��r�oJ� <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Projec[: _New_Addn _Alteration_Repair Type af Project: _New_Addn�Altora;'on_Repair <br /> S�owNumber(#)o/(xfures ShawNumber(A)o/frxtwes <br /> � AIC—air handling units To�let <br /> I Forcetl air s stems BathWb <br /> I Gas plpm ( Lavalo (wash basin) <br /> Water heater ' � Shower <br /> � Gas fireplace Kitchen smk 8 tlisposal <br /> I Gas ran e Dishwasher <br /> I Clothes dp•er I Clolhes washer <br /> Ran e hood Water healer <br /> Exhaust fan � � Smk iservice/badmcpletc.) <br /> � Heat pump Backllow preventer <br /> I Urnt heate� I Unr.�I <br /> � Boiler � Dnnkinq Founlam <br /> Relri cralion � � Ploordrein <br /> I Wootlstove Grease hap <br /> Ductin Roof drains <br /> � Other Medical Gas <br /> SPRINKI.ER / SUPPRESSION SYSTEM � other: <br /> Number of Heads � Other <br /> I nereby cemry iwt i nave maC ana eeamv�ea m�s apci���An anC know me same io be We anC mrtec6 Ni pmvisions ofiaws and orChances govem�ng mis type o:wark w�ll be campneC <br /> wAt1 w�elher sD�eC 11emn or not.Ti�R g2nting�!a perm�t Coes nol pRsume lo givc�utnamy to vrolale or W nCel Ne Ovvivon ol ary ot0er slate nr btal Uw regulating ccnslrUr�on <br /> at i am auNonxeE Oy�ne owner oi N�s D��erry to pertartn Ne work lor whlc�apDtiraian�s made ana i compp.ec�t�e S�aie Cantndars law tB 27 RC�V anE 296 ZOOA!'7AC <br /> 1 1 <br /> OwnerlAulhorized Agent Signawm Date � (Fevised 620�2i <br />