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pEI�MIT API'L.ICATlON <br /> BUILDINGIMECHANIGAL/PLUMBING/SIGfVISPRINK�ER/DEMOLITION <br /> CITY OF EVERE7T PERMIT SERVICES <br /> 3200 Cedar St., Everelt, W!�98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br /> APPLICATIGNS ARE ACCEPTE�FROM 8 AM TO 4 PM <br /> SITEADDRESS: ��,�. PftOPER�(V7A%N PERMITO _� <br /> � ��� � <br /> LEGAL for new consfrucfcn�. Short PlaUsubdivision Lol No._ (altach copy o�lon9 legal tlestription) <br /> OWNER PhonelE-rrail <br /> Address City/Slalerzip ^� � <br /> APPLICAPIT: OWne� OWnefSAg^�t �Co�U�'.dOf COn�r3C�ofSAgeO� _TEn3n�(musipm4iCaabticrnlr.nsem�mm:�arnncrmCexorkin�`�os,�col <br /> CONTRACTOR � �'—� �-��"���L-<«(�.J � g I lic.# " COE Bus.Lic.# <br /> —7O ��.� 12;�� �,�.Cd��-� �� PhonelEmail <br /> Address / � <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> ��� �' ��I �ZL <br /> PhonelE�mail <br /> BUILDING PERMIT APP4ICATION CON7RACTPRICEOFwoRK <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building Gas_ Electrc_ Other__ <br /> Building type: _Single Family _Dupiex_Townhouse _Multi-Family _Commercial <br /> Type of project: _New _Addition _Remodel _Repair_T.I._Sign_Sprinkler__Demolition_Change of Use <br /> JCRIPTION OF WORK(adtli(ionul space provioed on the back): � <br /> �DL��u.at���n o�, o{= C��i�►..�,.��p �E,-�-��"z- �+-z�r � <br /> �t:T1—�tT �I.eav��t9 faktidafi'ort t�oU <br /> MECHANICAL PERMIT APPLICATION PLUMBING ERMIT APPLICATION <br /> TypeofProject: _New_Atldn _Alteratlon_Repair TypeofProJect: _New_Adtln _A��eralion_Repalr <br /> Show Number(N1 0!lixfums Shaw Number(#)ol/iaYures <br /> NC—air handiing units Toilet <br /> Forced air systems BathN6 <br /> Gas piping lavato (wash basin) <br /> Water heater I Shower <br /> Gas fireplace Kitchen sink&disposal <br /> � Gas range Dishwasher <br /> Clothes dryer Clolhes washer <br /> Range hr;od Water heater <br /> Exhaust fan Sink(servicelbar;:noplelc.) <br /> Heal pump Backflow preventer <br /> Unit heater I Urinal <br /> Boiter � �'�nkmg Founiain <br /> Refrigeretion Flo;r drain <br /> Woodslove Grease Irep <br /> Ducting Roof drains <br /> Other Medical Gas <br /> SPRINKLE�2 l SUPPRESSION SYSTEM Other: <br /> Number o(Heads Other: <br /> I hereby cetlily I�al l lmvo read ond examine0 Nif opplkalion antl knmv Ne snmo la Oo tmo antl conecl All pmvisions of larrs and oN�oncea Boveming Ihie lype civiork w10 Do wmplicd <br /> wAhvAiol�ersDeci� tlhercinornoLT�eB�antingolapertniltloesnolpresumetoOivaauNontyladolalao�cancellhopmrs'ronolanyoUerstolearlocalbwmgu�atingconstruclion <br /> Thal l om au nm Ihe owner ol Ihia properry to pertortn ma work forw�K�applicalion la matle ontl I compy wah I�o Slela ConVaclon Low 18.27 ftCW en0 Y98.YOOA WAC. <br /> --�.��L 6� ,Lv !3 <br /> �,..DahcrlAuthodzed Agent Signature Date (Revised 5/2012) <br /> � <br /> — — _'. �a <br />