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PERMIT APPLICATION <br /> BUILDING/MECHANICALIPLl1MBING/�IGN/S�RINKLER/DEMOLITION <br /> CI �-Y OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, '.NA 98201 425-257-8810 FAX 425-257-8857 ww�ri.everettwa.org <br /> I ` 'o1g -1 <br /> SITE ADDRE55: PROPEN7Y TAR t! PE 1IT _O� � , <br /> /oy0 D s oo� a dc�oy�o <br /> LEGAL lar new eonslruction: Short PlaVsubdivision I.ot No._ (allach copy o(lon9 Iegal desaiption) <br /> OWNER /L i�+c_ (i/J�LQ�?ZO Phune/E�mail G�y'�J-��O�'"1 �� � <br /> naa���5 j0 S6a lo �2- �� aiYis�acer�n E✓Fn�tf j!- � — 8� <br /> APPLICANT: O�vner _OwnefsAgenl �CoNractor _Contiactor'sA9enl _Tenan��r.,�s�o:ohee.,iecerormm�•mo-�mmoown^rmaoM�oni�,;n:,p,,«� <br /> CONTRACTOR ��/�/✓/7 v /'Ln7 ��T ��'{'�(T Sla�e Lic.# ,�f� �P 2 City Bus, Lic !lO�VI'� I <br /> �dtlress � � �t//� ,j PhanclEmai; ���7��`YfQ <br /> TENANT BUSINESS NAh1E CONTACT FOR PERMIT /��� L+L��{, <br /> CJ <br /> Phonc/E-mail -7�]i <br /> EiUILDING PERMIT APPLICATION CONTRACTPRICE OF WORK_�y��_ <br /> Exisling Use of Bwlding _ HEAT SOURCE: <br /> Proposed Use of 6uilding Gas_ EieUric_ 011ier___ <br /> l3vilding lypc �Single Family _Duplex_Townhouse _Multi-Famlly _Cemmercial <br /> Type ol pie�ecl _ flew _ Addilion _Remodel _Repair_ T.I. ___ Si9n_ _ Sprinkler__ Ozmolilion ,Change o(Use <br /> �DESCRIPTIONOFWORK(aCtlrtronalspaceproviAedr,nmeback) �E��.� �5�01918/Z�Lf'� �'�'7�"�L <br /> �2✓IC� 1� �d"l1ll�'l. �i � �lil� /l�-�f�L Tb �{-�� /�CYl'1�. <br /> MECHAPIICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> TypoolProjeU: _Nc�.v_Addn _Allcration_Repair TypcolPmjec�: _Ne:i_Addn �llcratlon_Repair <br /> Show Number(#J o//ixlures Shovi Num6cr(kJ el(ixtures <br /> NC-air handling units roile� <br /> � Forced air syslems � DaQilub <br /> � Gas piping _ Lavalory(wash basin) <br /> � VJater heaier � Shovier <br /> � Gas lireplace � Kitchen sink E disposal <br /> � Gas range _ Uishv+ashcr <br /> � Clothes dryer � Clolhes washer <br /> � Rangc hood � Waler he&�er <br /> [zhausl lan Sink(scrvice/badmop/elc.) <br /> lieat pump f3ackflow prevenler <br /> � Unit hcater � Utinal <br /> � E3oiler � Drinking Fountain <br /> � Re(ri9eralion Hoordrain <br /> � Woodstove Grease Irap <br /> � puc.�ing � Roof drains <br /> � Olher � Medical Gas <br /> SPRINKLER / SUPPRESSION SYSYENi f � Olher (t/�j�L S�fLVIC�_ <br /> INumbcro(lir.ads I Olher. <br /> I nercby cciLly iAal I h�vc rcaA and c.am�ncd I�i;appllcaGon and tnow the samc lu be Iruc and mrmcl.All pwvisions ol laws and m�Inanre:9wcmin9 ihis IYPe ol vimk will be mmphcd <br /> �tiiit�vdiclh^rr�pecA�eAtrnr:��ornol R�e9ranlingolapMm��Idoesnolplesumel0giveauVmnlylnvio�:tleorumcellhepiovkionalanyol��r.lalr.orlocallawle9ulalin9conslNdion <br /> TMI I am n���orizM�y:hr oa�cr ol Ihis pmpcily lo pertorm Ihe noik lor v:Mcli ai�pli�:alinr,i,made anJ I comply wnh Ihe Slate Conhaclas la+i IB.27 RCW and 376 20DA WAC. <br /> , 1��8,�5 <br /> Ow� dA miii��genl5ignntu �� ��- Dale (/lgvlsed7R0i.7) <br />