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PERMIT APPLlCATION <br /> BUILDING/MECHANICALIPLUMBiNG(SIGN/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 /> S � �`-�"� <br /> SITEADDRESS: � ,/ PRO�Y7ERTVTA%N -7 PEftMITn <br /> Q Gu-�— G L c�L�IOO � ` S <br /> LEGAL lor new conslruc�ion' Short PlaVsuhdivision Lot No._ (allach copy of lon9 legal descrip�ion) <br /> OWNER Phone/E-mail G — �S�d� <br /> nAdiess Gl�� — �G-Q ��� Ci�ylSlatc2ip <br /> APPLICANT:__Owner OwnersA9ent _Conlraclor Conlractor'sA9ent TenantlR��=�;m��aoaicn�rmmos�oirommo��rnrnoecwo����mosv,:.e� <br /> CONTRACTOR late Lic # d (r 0 � .�ily��s. Lic.# <br /> �ddress ��j � ' �Uv-� (/Y � 'honelEm�il <br /> TENANT BUSINESS NAME CONTACT F R PE MIT <br /> PhondEmail 6(�'�� �^—��5� <br /> BUfLDING PERMIT APPLICATION CONTRACT PRICE OF WORK S� <br /> Cxisting Use of Bmlding_ HEAT SOURCE�. <br /> Proposed Use o(Building Gas_ Elech�c_ Oiher <br /> Bwldmg�ype�. XSing!e F�m�ly _Duplex_To�,+nhouse __�Jlulli-Family _Commercial <br /> i � <br /> Type of project�. PJe�v _ Addilion Remodel _Repair _TJ. __Sign_Sprinkler_Oemolition __Change ol Use <br /> DESCRIPTION OF WO (aCtlrlional spaceProwdedon Ihe 6ack): <br /> � A�� <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type ul Project: _New_Addn _AlleraUon_Repair Type ol Project: _No�N_Addn _Alteration_Repair <br /> Show flum6cr(NJ ollixfures Show Numbrr(d)o//ixhucs <br /> NC—airhandlingunits I iailet <br /> � Forcedairsyslems I �alhlub <br /> Gas piping I.avalory(wash basin) <br /> Water hea�er � Shower <br /> Gas Irteplace � Kitchen sink&disposal <br /> � Gas range Di;hwashcr <br /> I Cblhes dryer � Cloth^s washer <br /> � Rangc hood Watei heater <br /> [xhaust fan I Smk(service/oar/mop/etc) <br /> � Heat pump � BackOow preventer <br /> � Uni�hca�er � Urinal <br /> � Omler Urinking Founlain <br /> � Refrigeralion � f`loordrain <br /> � Woodstove I Grease Irap � <br /> Dudmg I Roof drains _ <br /> � Olhcr � Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM j other <br /> NumbcrofHcads ; Olhec � <br /> I hereby cemly Ihat I have reaJ nnd eram�ned IAi:apphwfon an�know IAe same lo Ge Imr.and corre�l.Ap ryovaions nl lavrs,nd mdu�ance:9oveming I�is lype ol wnrk vrJl�e cnmp'md <br /> n�i�h whelhe�,pea`retl heicin a�nol.7he gianling ol a pc�mA docs nol C«�ume lo grve awhonly lo violale or wncel the pmvi:ion ol any oNer slale or local law ie9ui�liog cnnstmrt�on <br /> ThallamauRioiize bylheowneroli�isp�opertylopeqotmlh�wortlarwhichapoli�ationL•moCezntllmmpPjwnhlheSlatr,ConVacto�slan1917RCVJan02962W��P.'AC. <br /> � - s ��/ ���� <br /> OwnedAulhorize 9enl51gnaluro Oale (Hm�i;ed9/JO1J) <br />