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PERMIT APPLICATION <br /> BUILDING/MECHANIGALIPLUMBING/SIGNISPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br /> / -33-� <br /> SITEADDRESS: � n I .7 � J�Q PROPERTYTAXp P RM�jp�o-hO <br /> 4, � G.. .Y/\ � �� � <br /> LEGAL for new consiruction: Short PlaVsubdivision Lol No._ (altach copy ol long legal descnplion) <br /> OWNERt'D{3YJ'v � �one�E�mail <br /> Address City/Stale2ip <br /> APPLICANT: Owner Ownefs�gen� �CoNractor _Coniraclar'sAgent Tflldfll(musipmviCea�anerolronsenllmm;nuawnerlodowodinl,iaspaca) <br /> CON7RACTOR � �-p.� tate Lic.# 02 fJCiry Bus. Lic.# �3 <br /> Atldress /�� �(� � �R,�LS wR- .Q PhonclEmail �p�2L� 3� (fN <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT � RE�,,�,,,icE F,RE <br /> �J iL'O✓� <br /> Phone/E�mail <br /> BUILDING PERMIT APPLICATION CONTRACT PRICF OF WORK <br /> Existing Use of Building p t f.IJ HEAT SOURCE: <br />' Proposed Use of Building �O�VI� " 'v""'� Gas_ Eiectric_ other_ <br />' Building lype: _Single Family _Duplex_Townhouse _MWti-Family _Commercial <br /> Type o(pwjecl�. New _Addition _Remodel _Repair_T.i._Sign_Sprinkler_Demolition_Change of Use <br /> DESCRIPTION OF WORK(addaionv space provided on trie nack) <br /> r N s r� r�`^�'g't�� �P�►�.�r,l�� v�� <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> 7ype ol Pro�ecl: _Now_Addn _Altero�ion_Repair Typo ol ProJecf: _Now_Addn _Alteralion_Repair <br /> Show Num6er(q�o//i+fures Show Num6cr(M/ol lixfures <br /> NC-air handling units 7oilel <br /> Forced air systems � Bathtub <br /> � Gas piping Lavalory(wash basin) <br /> � Water healer Shower <br /> Gas(ireplace � Kitchen sink&disposal <br /> Gasrange I Dishwasher <br /> Clothes dryer � Clothes washer <br /> Range hood Water heater <br /> Fxhaust lan � Sink(service/bar/mop/etc) <br /> Heat pump � Backllow preventer <br /> Unit heater Urinal <br /> f3oiler Drinking foun�ain <br /> � Relrigeralion � Floor drain <br /> Woodstove Grease Irap <br /> Ducling � Roof drains <br /> Olher Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM Other: <br /> � Number o(Heads � Other: <br /> I hereby cenAy Il:al I hsic iead nnd evamined Ihis appir.alion and Fnow Ine same Io be Ime antl conep.All provi:wns ol laws and ar<Anmices 9overmng Ihis Iype ol work wiil�c compSeE <br /> vnth whcther sDecd�etl�crein or not lhc granling ol a Dermit Gocs nol pm;umc grvc auNor�y lo vlola'e o•rana�l I�c prowvon ol any o�hcr stalc ar laal Inw icaulating ronsimdinn <br /> That I a aul�orlEc�Ey Ihe a er ol ltus propetly lo petlo�m Ibe work lor cti aDD����on Is made anE I wmpN N'���ifre Siale Contrntlois Law 19 77 RCW antl 296 700A WTC. <br /> l�/�� O 3(/ { <br /> OwnedAuthorizcOAgentSignaturo pal " I � (Revisr.dJ?019) <br />