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PERMIT APPLICATION <br /> BUILDING/MECHANICAUPLUMBING/SIGNISPRINKLERIDEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 425-257-8870 FAX 425257-8857 www.everettwa.� �,/ <br /> �r� <br /> SITE ADDRESS: PROPERTY TAX N PEMII M <br /> 2117 y9�� ST SC � �R�2GFti r � <br /> IEGAL fot newconstrucLon. Short PlaVsubdnision Lot No_ (attach copf��I long legal desaiplion) <br /> OWNER CRRL A � �To�le Phone/E-mai� N1S11^S� OG C0.+ • �� +✓�a� �•�"" <br /> ao��5 211� �14� ST SE CvE�2eFE GrylSbteZp Evevr�-E Wh q ��°3 <br /> PPLICANT:!Owne� _P+nefsAgent Cortlraaor Cantraclor'sAyent Tenanti�.niao�c�e.::�o�wmcRi��mco.�*��mm.AMr.r�s��� <br /> CONTRACTOR DW�e{� Stale Lic.p Cily Bus.Lic.M <br /> ���5 PhonelEmail <br /> TEN NT B S E S ME CONTACT FOR PERMIT <br /> %'/}J2L. C-�12P�e <br /> pneneiE�mai� 425 u3S �aNGG CRrI. �•��"oVeF�,�l� <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Erisling Use of Building�V�� HEAT SOURCE: <br /> Proposed Use of Buildinp xOw� Gas EJectnc Other <br /> Building lype: � Single Family _Duplex_Townhouse _Mufli-Fartdly _Commercial <br /> T of o'ed New Addilion Remodel Re air T.I. Si n S rinkler Demolition Chan e of U�e <br /> DESCRIPTION OF WORK(addrtiona�speoe pmvidoa on�ne oech): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERII�iT APPLICATION <br /> Type of Project:,�New_Addn _Nterotbn_Repalr Type ot Pro�ect: _New_Addn _AiMration_Repair <br /> ShowNumbw o/firtures ShowNumber o/(uYures <br /> AIC-air handlin unils T01�e� <br /> Porced air s tems BalhWb <br /> Gas � �n Lavato wash basin <br /> Weter heater Shower <br /> Ges Rre lace Kitchen sink 8 dis sal <br /> Ges ran e Dishwasher <br /> Clothes d er Cbthes washer <br /> Ran e hood _ Water heater <br /> F�haust fan Sink servicrJbar/mo lelc. <br /> Heat um Backflow reventer <br /> Unit heater Urinal <br /> Boiler Drinitin Founlain <br /> Refri erahon Floordiain <br /> � Woodstove Grease tra <br /> Ducti Rooi drains <br /> Jlher Medical Gas <br /> SPRINKLER / SUPPRESSiON SYSTEM other: <br /> Number of Heads Other: <br /> I heleEy ceNry Itut I l�avc maC an0 exemTed�h6 aDD�KaCon anG brow Uc 6ame lo Dc bue an0 wrtCct.NI pmveroru ollawe anC oNinancee povcminp Ns rypc o1N9rk�7 Dc tompl <br /> w'Ji wtminer sDeciMU I�erem or nat.The parNnp o(a peimrt Coee nat D�esume to O�e aut�omy to vrola�e or cancel the p�wman of airy othv ctate or bcal mw repulata+q comtmc0on <br /> 71u1 I am aumrrlxeE y 1Pa ow�erol a pmDeM�o pertortn Ihe r.oik br wtirc�eDDlcation e maEe enG I compN waA l�e State Canuaclon law 10.Z7 RCW aM 296 200A WAC <br /> ' erlAu hwl2�`�n pn0ture Date (Rewsed 32074) <br />