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''ERMIT APPLICATI� <br /> BUILDING/MECNANICALlPLUMBING/SIGNISPRiNKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St , Fverett, WA 98201 425-257-8810 FAY 425-257-8857 vn�nv everethva org <br /> � -���/ <br /> SITE ADDRESS: �2I O 6.(� � PROPERTY L1%q PERMIT# I Z � O� / <br /> LEGAL fo� ra+i consVuclbn Shon PIaL'suG]ro�y�on I�:Ku falto_I'. c:;/c'I_���icgul tlescnption) <br /> OWNER Prronr'E-mai� <br /> �.daress Ciiy�State'Zip <br /> APPLICANT:_C:me� O+mersF�em �Convacl�r _CONracior'sAgen! __Tenant��,;.n;�o�c•ai�ec,da�:.-i�v�-�c�.cw�.e:ioa-.�c+��,i^..•i.�.: <br /> _ I <br /> L'ONTRACTOR S K �.✓�� ����' Z+n L State Lis � �� wA �- -I I� �h Crty �us Li�. # <br /> p d / <br /> 4tld�ess �0�00 5 4f �d✓(.� �i(; 4Y� � Or Pncnc�Enn �e �7 �0 7 )7� <br />� TENANT BUSINESS NAME CON ACT �OR PERMIT <br /> �M�',1 � I ��^�e 7.n�. ^henc'L.�m.ai: <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK__ !D • _ <br /> Fx�.sbng Use of Bu,ljing HEAI'SOURC� <br /> Proposec U�sa of Dait;iirg r:.s_ _ Eieclnc_ O�ner__ <br /> Bwld�ng lype _Single Family _,Duplex_Townnouse _Mulli-Famdy '�Comm�raa! <br /> f�pe of p�o�ec; ___ Nz:v _FldhiUcn _Remodel _ Repair__T.L _ Si^,n __ Scrn�aler _ Demolihon__Chan^,e of Use <br /> DESCRIPTION OF WORK,�ad7 t on;.sr�ce pro�nded on tne oac�- � <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type ol P�oject: _Ncw_`�Addn _Altcratmn_Repav Type af Project _New_ _ Addn __Alleralion_Repair <br /> Show Number(q)o//ixtu�es Show Numbcr(pJ o/hxtures <br /> !llC -air hantll�ng unils To�iet <br /> � Forced au systems '' Bahtub <br /> ' Gas piping i Lavalory (wash basin) <br /> � Wdler healcr ShC:�et <br /> j Gas Lreplace � Ktichen smk E d�sposal <br /> Gas ranqe Disl��r�asher <br /> Clothes dryer � Clothes washer <br /> Range hood I Wa:er heatr.r <br /> Exhaust fan � Smk(servicelbadrnop'etc I <br /> Heal pump I Bachqo•n�prevenler <br /> Unit healer I Unnal <br /> Boilcr Dnn'r,�ng Founta�n <br /> � Refnqerahon j Rer.� �''ain _ <br /> I VJoodstove I Gre:, ��ap <br /> ! D:,c6n:� ' Rocf,; ��s <br /> � Oiher i Medica'� Gas <br /> SPRINKLER I SUPPRESSION SYSTEM � omer. <br /> � I�umher of Heads ! Olher. <br /> I�eieEy cen ly Ihal 1�ave r-i�n^,J e.amine0��'s appC:a'.on antl tn�.v Ihe same Io Ce Ime an0 cortecl All provisrons ol lans untl cr��nunws 9overmng Irv.c IyCe ol woA h���i be compP.etl <br /> v.dh�.he�her spcuLeE�err.n or rcl 7ne t�'an'in3 0l a perm��:Goes�ol p2swr'�e lo n�:e u:�omy to v:cldte ar can.e�1�e prowsion of a^y othe�slate or loeil IaH�e3ulalinq consimUion <br /> m�ni:vn:w'i��on:ea[�In�o:me 'tn�spwpe�ylopedorminewcnJornn�cna,i:lca'-�onn���s>•an�Iccmp,�wilntneSlaieLonlractorsla«1BP7RCWnnd796200AP(AC. <br /> v �`� z�l� <br /> Owner/Authorii Agcn Si nature Da12 (Revised 320131 <br />