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PERMIT APPLiCATION <br /> BUILDING/MECHANICALIPLUMBING/SIGNISPRINKLER/DEMOLITION <br /> CiTY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everelt, WA 98201 425-257-8810 FAX 425-257-8857 v�nvw.everettwa.org <br /> �3 !- /�/ <br /> SITEADDRESS: PROPERTYTAXM P MI7# <br /> �7� — d 5 O (`� L- <br /> LEGAL!ar new consimclirn: Shorl PlaVsubdivision Lot No._ (alWch copy ol long le9al desCtiplion) <br /> OWNER (�, C �� Phone/E-mail 1�7�-�f -� <br /> Address � SE CitylStale/Zip O IS O�7� <br /> APPLICANT:_Owner _OwnefsAgent �CConlraaor _.Conlraclor'sAgent _Tenantlmosip�o.,eeai�r.e�or�ors�r.ir.eminao.nerioaowo�tnm�spacq <br /> CONTRACTOR D/�/,y�/� tt f� . State Lic. # � �/1/ y�(�QCily[ius. Lic. #Q�"17 <br /> llddress ��� �3 �, [_�/.�11� G(/Q� �' Phone/Email ��j-77�rp �p <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT B�� Q��l�� <br /> Phone/E-mail —7� <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK �7(0. <br /> Exisling Use o(Building HF1AT SOURCE: <br /> Proposed Use of Building Gas__ E�edric_ Other_ <br /> Building type: � Single Family _Duplex__Townhouse _Multi-family _Commercial <br /> Type ol pro�ec� New Addi�ion Remodel Repair __TJ. __ Sign_ Spnnkler__Cemolition_ _Changc ol Use <br /> DESCRIPTION OF WORK (avd�;mnalspaceproviUcdonuiceackl (,�//��� (/�/T� ,4NO �/��j— �"A0� <br /> IVIECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPl.1CATION <br /> Typo of Pro�eck _New_Addn _Alleralion_Repair Type of ProjcU: _New_Addn ,�(Allcralion_Repair <br /> Shorv Number(p)ol lix(mes Show Number(qJ ol lixfures <br /> NC—airh�ndlin9unils � Toilet <br /> � Porced air systems I � �athlub <br /> � Gas pipiny I Lavatory(wash basin) <br /> � Walenc�aler � Showcr <br /> � Gas fireplace � � Kilclien sink&disposal <br /> � Gas range � Dishwasher <br /> � Clothes dryer � Clothes viasher <br /> � Ranye hood � � W.�!ci healcr <br /> � Lxhaust lan I ;ink(servieelhadmop/e.lc.) <br /> lieat pump � Uackflow prevenfer <br /> � Unit heater � Urinal <br /> � Doiler I Drinking Faunlain <br /> � Refrigerelion Floordrain <br /> � Woodslovc � Greasc Irap <br /> � Ductiny � Rooldrains <br /> Other � Medical Gas <br /> SPRINKLER I SUPPRESSION SYSYEM I other <br /> � Number of Heads � Olher _ <br /> 1 ne�eby ceroly Ihat I her+e�ezd anJ ezamined I�is applicalion and know Ilm samr.Io Le Ime.ind eoired.All pmvrt+nn.ol lave anJ oiainances 9wemin9lAis t�pr;ol woik wvi he eompSeJ <br /> wilt�wh^I�er speuG^U�e�an or noL T�e granling ol a peuml does nol piesume l0 9ive avlhorily Io violale ar can�el Ihe pm��ision ol any ether:lale nr lowl�aw�egulaling consimcilnn <br /> Tlial I am aul�o�iteA by Ihe owner ol IhiS pmperty lo peN,orm Ihe work for w�icb applrtnlion is maae and 1 comply wiih Ihe Slalr CoNraclois l aa�10.17 RCW antl 296 200A WAC <br /> OvmerlA orizeJ Agcnl Signalu / ��c (Reviscd J/7017J <br />