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PERMIT APPLICATION � <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-6857 wvvw.everettwa.org <br /> -2o - I <br /> SITEADDRESS: � PROPER7YTNfp PE I�q 0 _Qi(F <br /> �,i(l <br /> LEGAL far new conslruclion: Shoh PlaUsu6division Lol No._ (attach copy of long legal descnplion) <br /> OWNER (�i Phone/E-mail <br /> Address 2 E CifylSlate/Zip �/Fjc�� �l <br /> APPIICANT: Owner Owner'sAgenl Contrador _CoMractorsAgent __Tenanl(m�siv�o�eseior.o:otca�s�mnon¢oo«rerioao.on�nmospaco� <br /> CONTRACTOR � Slate Lic.N Cit Bus.Lic.# <br /> Address Z�Z �j'Y� �jf/ 9�z Phone/Email <br /> TENA T BUSINESS NAME CONTACT FOR PERMIT <br /> C�{U � Phone/E-mail 2� � Z ��ZZ <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK ' �GG — <br /> Exisling Use o(Building NEAT SOURCE: <br /> Proposed Use of Building _ Gas_ Eleclnc_ Oiher_ <br /> Building type: _Single Family _Duplex_Townhouse _Multi•Family _Commercial <br /> i <br /> Type ot pro ect: New Addition Remodel Repair_T.I._Sign_Sprinkler_�emolition_Change o(Use <br /> DESCRIPTION OF WORK(adddiona�space prov�dedon me back): <br /> �fVl er- <br /> MECHANICAL PE MIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Typo of ProJor.t: _New_Addn _Alteration_Repair Typo of P�oJoct: _Now_Addn _Altoratlon_Ropa(r <br /> Show Numbcr(M)o//lxfures Show Number(p)o!/Ixtures <br /> NC–air handling unils Todel <br /> � Forced air systems 8athlub <br /> Gas piping Lavalor (wash basin) <br /> 'x Water heater Shower <br /> Gas firep'ace Kitchen sink 8 disposal <br /> Gas ranqe Oishwasher <br /> Clothes dryer Clothes washer <br /> Range hood Wate�heater <br /> Ezhaust fan Sink(servicelbaJmop/elc.) <br /> Heat pump � Back(low preventer <br /> Unit heater Urinal <br /> Boiler Drinking Founlain <br /> Relrigeration � Floor drain <br /> � Woodstove � Grease Irap � <br /> Duc�ing Roof drains <br /> Other Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM Other. <br /> Number of Heads � Other. <br /> I�ereby ce�Ay Ihnl 1 have ieatl and eaamined�his apD��wM1on an7 know��e same�o be�me nnd cormct.All pmnsions o11sMs ond o�tl:nances govemin�th:e type ol woM1 vn'I be tomplied <br /> 'h w0cl�er specRicO herem o1 nol 7he gr�nling ol a pertn9 tloes not presume lo gNe aul�omy lo violale or tantcl l0e pronsion ol any athel slate o!lowl Idw Iegu4tling fqnswnion <br /> �a1 I am autnonzed Oy I�e owner ol l�b pwperly lo Dedorm Ue woik lor v.nlch aODlicalion Is maEe antl I wmply wAh Iha Slate Conimtlors La.v 18 77 RCW anE?96 200A WAC <br /> � - _ ��.! <br /> O nor A thori:ed Agent Ig ature Date I (Rovised]R019) <br />