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PERMIT APPLICATION <br /> BUILDINGIMECHANII;ALIPLUMBING�SIGNISPRINKLERIDEMOLITIOPI <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Cverett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM � a 7`��' <br /> PROP TITA%p P MIT� _D(- <br /> SITEADDRBSS: /7 �L�o I`��`'���E S� 2�`053�^-�'� l�`y>oo � ��� <br /> � <br /> LEGAL fornew cons�rucliorc. Short PlaVsubdivision <br /> Lol No._ (altach copy o�lorg legal descnption) <br /> OWNER �/'1 '��� U�S�G�"�' PhonelE-mail /4S"-�76 -�7�5 <br /> ! p� ^ �1C-��/% IiWP, . ��l-�� <br /> Address Z��iW I / �/� n�f-` /��'' CitylS�at+/Zip <br /> APPUCANT: O�mer Ovmer'SAgCnI J�Gonlraclor _ConlydctorSAgenl _Tendntlm-,nom.�aeaieve�a+cc,senuromceo�enoao»on�nmesca:e; <br /> CONTRACTOR u�/G�N��{� /�� u�� �J'�#"�(�E' L 8 I Lic.# J�{iCl�R�S�+(.�3J�J COE Bus. Lic.# <br /> Address �C✓�b /'��/�.� �` h���Fil�. �F . `101��'� PhonelEmail y� '" 7J%_��+" O <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> PhonelE-mail v^arlJ �'�'G �LS- /���`��ii��1 <br /> BUILDING PERMIY APPLICATION CONTRACT PRICE OF WORK �' <br /> S� � NEAT SOURCE: <br /> Existin9 Use o(�uilding � — <br /> Ga Eleclric_ ��her_ <br /> Proposed Use of Building �>F�" � <br /> Building type: �Single Femily _Duplex_Townhouse _nM/ulti-Family _Commercial <br /> Type of prolecC __New __.Addition __ Remodel __Repair(/�--T.I. _ _Sign__ Sprinkler_Demolilion_Changa of Use <br /> DESCRIPTIONOFWORK(additlonalspaceprovidedentheback): /E� �/� U.�lr �/./a ��> ����`��k <br /> /'-c�F/-/�l,'n/G� GaF� F�I•./✓Flf� /�rlC R4�//✓�{ /�i /• ��NcW�r,JG <br /> 4At FI�iN(�� <br /> MECHANICAt PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of ProJecC _Now_Addn� .Alteralion_Repair Typo of Project _ New_Addn _Alteration_Repair <br /> Show Number(#)o/Iixtures Shaw Number(#)o/frxWms <br /> � A/C-air handling units I Toiiel <br /> � Forced air syslems � Bathlub <br /> � Gas piping I Lavatory(wash basin) <br /> Water healer Shower <br /> � Gas(ireplace � Kitchen sink&disposal <br /> � Gas range � Dishwasher <br /> � Clothes dryer � Clolhes washer <br /> ' Range hood W:�ter healer <br /> � f_xhaust fan � Sink(seraice/badmop/elc.) <br /> � Heal pump � Backflow preventer <br /> Unitheater � Urinel <br /> Boiler � Drinking Fountain <br /> � Refrigeration I Floor dra;n <br /> Wcodslove � Greasutrap <br /> � I <br /> � Ducting Roof dr,ics <br /> I pther � Medical Gas <br /> SPRItJKLER I S!JPPRESSION SYSTEM � Other: <br /> � Number o(Heads � Other. <br /> i he«:h�r.uruy Ihal l liavn.reatl an�e*aminetl Ihis nO4lkatqri a�'A know Ine same to be Ime and cortec:.Ail pmvuions ol laws anE orAinances goveming Ihis IvVe of wak nill Ca com0��tl <br /> �n�,!h v.twtin;�specAm�nerein or nol.Tno grantirg ol a OermA eoes not presmno to gi�o aol�orAy la vro!a10 or wncel�ho pmvision ol any o�her stalo or bcal bw reguW6ng mnsUuclion <br /> Tha!I am a•.i0/,�f�/�Gy I� owncr of ihis property lo pedurm Ite work Icrwhnh appLcatnn rs ma0o and I comOty wAh No Stalo Contractors Law 1827 RLW and T96 200A WAC <br /> �/ <br /> �� ��J //-7�;Z <br /> OwnerlA horized genl Signalurn <br /> Dale (ReviseA 6�2072) <br />