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. • -j� �� <br /> � <br /> PERMIT APPLICATION <br /> E3UtLDING/MECHANICALIPLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITI' OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 425-?57-8810 FAX 425-257-8857 www.everetlw�a.o�rq5 <br /> APPLICATIONS ARE ACCEPTEO FROM 8 AM TO 4 PM /� c�E'/ `I/ <br /> SITE�DDR�S: /� � �! �r PROPERTV7AXq PERMITq _ � <br /> � ) �C f��`�C�- <br /> LEGAL lor nnw construclion'. S�orl PiaUsu6division Lol No. (a�lach mpy of long legal dcSC�p�ion) <br /> �- ' — <br /> OWNER JC, ' O �^ Pnonc/6mail s� U�— S Z l_.�.�n o�V��,-vt � S (� <br /> naares: �a, 3 2. �i f` �� S� cnv�s��rorz�v �.ierc� �-�/a- �'id'2 �6 Ms lv . <br /> L��� <br /> APPL�CANT:�_Owner Owner;Agent Contraz�or Conlractor'sAgenl TenaNf�.�siv�o���oaec��oico�.�•�ii.9mmav..,�e�ma�wrv��mosPac�� <br /> CONTRAC'i OR i / W r 1 L 8 1 Lic.# COE 6us. Lic. tt <br /> Address PI�nNEmail <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Phone�E�matl <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Exis�mg Use of Building HFAT SOURCE <br /> Proposed Use of Buildina Gas_ Electric o�her <br /> �uilding lype: ,o�Singte Fam�ly _Duplex_Townhouse _Multi-Family _Commercial <br /> Type of projecL New Addition,.!f�Remodel Repair_T I _Sign_Sprinkler_Demohtion__Chanqe cf Use <br /> DESCRIPTION OF WORK(adddional space prooidetl on rhe bacHi�. <br /> �(^' S �%Yl C � FU r n C C � 1 I�Y/'G�� <br /> MECHANICAL PERMIT APPU�CATION PLUMBING PERMIT APPLICATION <br /> Type of Projecl: _New_AdOn _Alieratlon_Repalr Type ol Project _New_Adtln _Alleraiion_Repalr <br /> Show Nomhcr(dJ ol lirtures Show Numbci(N)ol lixfures <br /> fVC-ar hantlling units Toi!et <br /> Forced air syslems Oalhtub <br /> Gas piping Lavalory(wash basin) <br /> Walcr heatcr S�1GN'Cf <br /> Gas fireplace Kdchen sink 8 disposal <br /> Gas rangc Uishwasher <br /> Clo�hes dryer Clothes washer <br /> Ranqe hood Waler healr. <br /> [xhausl Gm SmY. (scrvice�b�u/mop/elc) <br /> Heat pump f3ackllow prevenler <br /> Unif healer Winal <br /> F3oiler Drinkin9 Fountain <br /> Refri9eration floor drain <br /> Woodstovc Grcase trap <br /> Ducting Roof tlrains <br /> Olhcr Medical Gas <br /> SPRINKLER I SUPPRESSION SYSTEM oUer. <br /> Number of Heads Other <br /> 1�empy cMRy I�al l�nve read an0¢enmmetl I�i;nVVlxalion m»�nnw IAe samo 10�e�vu anJ r.onrd.NI pro�¢ion;ol lavn anrl orAinance:(�wemmp iNs NAo alvmrk vnil Gu cornphutl <br /> WA�1 W�1C:��ff ipC[ifiCl�IlClllll o�IIOI I IIC�f:lllllll�OI11�ICllllil(�OC911OI pICi11R1010 0���•�1u111011:/�n VI01.1�11 O!CilllCl`I IIIO{�IOVISIn1141:IfIY OI�II•I'.I.)�I:O!IOC:11 LI�V ffnl�l�ll�l'1�[011�1lIICIi0l1 <br /> T�al I am aumonmJ py Ihc owncr oI1M1l�pmpeM lo perlorm Rio wmh lor vi�¢li uDPl:cnbon i�ma�n nnd I camp�y vnlh Itin Slalc Gnnlruc�or;I.nw 10 2712LW w�J P90]O��W�G <br /> � �- �� S- �� <br /> Ownclf u rized A9rnt Signature D�Ic (Nevrsctl GROt?) <br /> � <br />