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s • <br /> � �ERMIT APPLICATION <br /> BUILDINGIIIiIECHANICALIPLUMBINGISIGN/SPRINKLER/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 /> APPLICATIONS ARE ACCEPTED FROM 8 AM TU 4 PM �� --oa -�3 <br /> SITEADDRESS: �� � — PROPERiYT.1%N Pr��T � 0� <br /> / � <br /> LEGAL lor new r.onsiruclion' Shari Plat/subAivis'�on Lot No._ (aUach copy ol long lepal descnplion) <br /> OWNER . ' /�IC. Phon�lE�mail �S'3(�g'' y7 (JC C � :(�`1ill�v(^�CAt <br /> Address ���0� Dh (_ Ciry/Stalc2ip �,/P1'�I l�� � <br /> APPLICANT: Owne� OwnefsAgenl Con�ractar _Can(raciof5�9en� _Tenan��mmiom.'aooionoro�mnsomnomn��owivrioaav.oa��m�scnm� <br /> CONTRACTOR .Z ec�in � C _ L 8 1 Lic. H ,02 Z�c 1�.In COE Bus. Lic.# �•T 1 Q6 <br /> AUdre55 ap�- � V� �/� (a Phone/Ema�l 3(� (7 �� Y 3�- v <br /> TENAN7 BUSINESS NAME CONTACT FOR PERMIT <br /> PhonclE-mail <br /> BUILDING PERMIT APPLICATION CONTRACT PRIGE OF WORK_7�� .� <br /> Exisling Use of Building HEAT SOURC[: <br /> Proposed Use of Building Gas_ Elearic_ O�hcr_ <br /> Building type: _Single Family _Duplez_Townhouse _Mulli•Family _Commercial <br /> T e of ro ecC. New Addition Remodel Re air T.I. Sign S rinkler Demolilion Change of Use <br /> DTESCRjIPTIOF.({,OF WOyRy/K� (ad/dilionai s(��,�o pmvidcu on Pon IA1ack/: � / ' <br /> 1^S I�G II���I W1 G l l.�lt� 1 �rr�L�LC/ `f� ��{'I kle5 s W�'�.�� ��Jca/�� I n �N11 <br /> -�( iS���. �P� I J��ICq.t� �lJl'�.Q'i , <br /> MECHANICAL PERMIT APPLiCAT10N PLUMBING PERMIT APPLICATION <br /> Typr,of Pro�eet: _New�Addn _Alteration_Repalr Type ol ProJect: _New_Addn _Alleratfon_Repalr <br /> Show Num6ar(17J o��xfuras Show Numbar(p)ol fixtures <br /> A1C-ar handlin units Toilet <br /> Forr.ed air systerns Balhlub <br /> ' Gas i m Lavalo wash basm <br /> Watcn c�aler Showcr <br /> Gas fre lace Kilchen sink 8 Ais osal . <br /> Gas ran c Dishwashr,r � <br /> Golhes dryer Clothr.s washer <br /> Ran�c hood Waten c�alcr <br /> Exh�ust lan Sink �servicclbadmop/etr,. <br /> flea� um BacY•�low rCvr.nler <br /> Unit healer Unnal <br /> 8o�lcr Dnnkm Fountain <br /> Refngeration Flnor drain <br /> Woodslovr. Grcasc tra <br /> DuGlin Roof drains <br /> Othr,r Medical Gas <br /> SPRINKLER I SUPPRESSION Sl'STEM Other: <br /> Number of Hr.ads n�h��� <br /> I�urcOY cetlily Iha�I havu mail anA nraminea Ihi:appiioilmn nml Nncw�hn�.mm�lo Ou We anJ cortucL All prnv¢ions al law.anA nrtlinnnras gavemir�Ihis Ipm ol woik vnV bn compimtl <br /> w�ll�whnNm:pueRi00�am'n oe not Tho 9ranbng ol a pprtn�Jao.no:pr0:umo lo g�+n avl�onty Io nolnln or wneCl Ihn ptovi:ion ol any nt�m SLila or Int.il I�w mgul�Gnq eon.W eLOn <br /> ITai I am aWhorvM by ihe owner o���is G�OcM�o petlorm i�c wort for whic�:�ppl r.au.,n is ma��:and I compty w�l�I�c SWIc Cumr;icioc L aw 18.L RC W antl�95 20CA W AC. <br /> y/ il// // �/� 7 /� <br /> OwncrlAulhoriied Agenl Slgnalme �ate (RevisedG/2012) <br />