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� • <br /> PERMIT APPLICATION <br /> BUILDINGIMECHANICAL/PLUMBING/SIGN/SPRINKLER/OEMOLlTION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br /> S'nt <br /> SITE ADDRESS: aaoPEaiv iax a P m1T <br /> 2 O-� � �a.. 5'E.'tsJ 4.er�,ct' I 0�('- 7�2 <br /> LEGAL for new consiruction: Sn aUsubdivisionl-/4'SCAC�� QRa-� Lot No�Z (a�tach copy ol long legal description) <br /> OWNEKjr+-At("l.� ��L�C"�- . +tti�S Phone/E•mail ¢LS 953-Z"uoQ <br /> Adtlress ],.p SV.S `Lw1�Z( YH'a'�'L �{ CitylSlate2ip �fc..fT (.1.�- l�l�1 � <br /> APPUCANT: Owner _OwnefsAgent Conlraclor CoMracrofsAgent Tenanl�musiorordeaieheroiwnsamimmmeownenoaowonmmesvaca� <br /> CONTRACTOR�`C9►1.T6-�� P� '��<<' 6�0''U'4L State Lic. MsFi.Tr 4�Oo SAt� City Bus. Lic.q ^Z1E(Y b.0 <br /> Address �j,A/yl/��L Phone/Email ��O.NA-�• <br /> TENANT BUSINESS NAME C0�C�.F�OR PERMI_ T _ _ _� <br /> (:/V�.aiJ"cYlr'��6Z <br /> PhonelE-mail �qZ 3S0 <br /> BUILDING PERMIT APPLICATION CONTRAC7 PRICE OF WORK <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use o(Building Gas� Electnc_ olher_ <br /> Building type: _Single Family _Duplez_Townhouse _Multi•Family _Cemmerciai <br /> Type of project: ✓New _Addition _Remodel _Repair_T.I._Sign_Sprinkler Demolition_Change of Use <br /> DESCRIPTION OF WORK(eod�t7ona�space provided on rhe back�: <br /> Zo-t. o P t�-� � ca� � �+,.�� - Q� I�FO 3-00� <br /> MECHANICAL PERMIT APPLICATION PLUMBING I��RM6T APPLICATION <br /> TypeotProject: �New_Atldn _Alteration_Repair TypeoiProJect: _New_Addn _Alleration_Repatr <br /> Show Num6er(MJ ollixtures Show Number(M)ol/ixtures <br /> � A/C-airhandlingunits I Toilet <br /> � Forced air systems Bathlub <br /> Gas iping Lavatory(wash basin) <br /> � Water heater •� Shower <br /> � Gas fireplace � Ki�chen sink 8 disposal <br /> Gas range Dishwasher <br /> � � Clothes d er Clothes washer <br /> Range hood � Water healer <br /> Exhaust fan ( Sink(servicelbarlmop/elc.) <br /> r- Heat pump Backflow prevenler � <br /> - Unit heater �"• � Urinal <br /> • Boiler Drinking Fountain <br /> Re(rigeration � Floor drain <br /> Woodstove Grease trap � <br /> Ducting Roof drains <br /> Olher Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM � Other: <br /> � NumberofHeads � Olher: <br /> I hereby ceddy Ihat I hevo mad and eaamineE this appliwlion antl know t�e same to be We ana corred.All provisions ol laws antl ordinan�.es goveming Ihis rype olwoM w�11�e complietl <br /> wd�whe her specRe erein ar no7.Tho granling ol a pertntl 0oes not presume io gNe euNanty to violale or cenui t�a pmvision ol any alher state oi laal law regulaling construclion <br /> TTaI I a w ¢e I� ner o/tMs properry lo pertartn t�e work for wtiirt�appiiwiion Is maUe anC 1 compty xil�Iha Slate ConVactors Law iB.T7 RCW and Y96.200.1 WAC. � <br /> r � v <br /> 4-z$- � 4 <br /> Ow e IAuthorizedAgentSignature Dale (Revised3/20f3) <br />