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PERMIT APPLICATION <br /> BUILDINGlMECHANICAL/PLUMBItJG/SIGNISPRINKLERIDEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES //�3—�z <br /> 3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 �w�w.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITEA�DRESS: PROPEftTY7A%q ERMIT# \ <br /> � rC" i• � l�_ �_ i . rtl �� .l1t�. - Ci=- `l��<(iC /`. £,i U�/ 2.�G —(�� <br /> LEGAL lor new construcbon� Shon PlaVsubdrvision Lot No._ (atlach copy of Iong legal descnpiroc� <br /> OWNERr•;,:`h �•��, r. .,; I_ ;i��_.i.fL� i� Phone/E-mail <br /> i�• <br /> Atldress �i`'�C` I J Ilv� l.: L'l�/1{� ��:���1��LC '. CdY�State2ip ��1.�� f�{; l.<+ti '�CL�_-: <br /> APPLICANT: Owner Ovmer'sAgent LContracmr ConlractofsFgen� Tenantim�sio�o�m�ai�n«ciro�senr�cm��.�o�..���aeok:,���m��.:.,:�� <br /> CONTRACTOR IJCc�{ti ��,�-,,,a (�,..:L'-cdo,�> ,.•�� LdlLic.# �.��r ;�{ h�����GZ�.i�� COEBus. Lic.# <br /> Atltlress �!`� //(. ,,. ��C <�t' �t�� , • �!� l,�l;Vl `�i.i�.; Phone/Email ���) �1-��-�C��� `!� <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> ��i�.�'. �ll.�.�-i... _ <br /> Pnoneie-maa �t�i' ; �� �c, (��I�f� <br /> BUILDING PERMIT APPLICATION coNTRAC7 PRICE oF WORK , I G� "" � � �C`-O l <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building Gas_ Elecinc_ Other <br /> Buildingtype: l�SingleFamily _Duplex_Townhouse _MWti-Family _Commercial � <br /> Type of pmjecC New ti� Addilion _Remodel _Repair_T.L_Sign_Sprinkler_Demolition_Change of Use <br /> DESCRIPTION OF WORK(adtlitional space provitled on tne vack): <br /> � � �� �j[C� � CJ1.�e: �= �J:v' ��L CL; <br /> �t <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATIQN <br /> Type of Project: _New_Adtln _Alleration_Repair Type of Project: _New_Atltln _Alteratlon_Repair <br /> Show Number(N)ol/irtures Show Number(q)ol fixlmes <br /> A1C-air handling units Totlet <br /> - Forced alr systems BathWb <br /> � Gas piping ' Lavatory(wash basin) <br /> � Water heater Shower <br /> Gas fireplace ' Kitchen sink&disposal <br /> Gas range � Oishwasher <br /> Clothes dryer � Clothes washer <br /> Range hootl Water heate� <br /> Exhausl(an Sink(servicei5ar/mopletc.) <br /> Heat pump � � Backflow preventer <br /> Unit heater Urinal <br /> Boiler �rinking Fountain�-, <br /> Refrigeration Floor drein \ <br /> Woodstove �\ Grease trap \ <br /> Ducting \ Ruof drains <br /> Other Medical Gas <br /> SPRINKLER I SUPPRESSION SYSTEM Other: <br /> Number of Heads Other: <br /> I Iwrepy caiLly Itial l hnw�e.uf artl e�Nmmril P.:S apphcabon und know Ilio samn lo be tme an�conect All pmvisions ol iarrs und ortlmances pavemmg I�is rype o�work mIi 0e compLea <br /> �n',li rAminor syeoluetl horein w nol ilio 9mnLn9 n!a ponnA doRs not presume to qrvo aulhonry Io violale or eancel t�e pmvisan ol eny olher slalo or lot'nl law requlaling eon'dmelion <br /> i nm I am auNonm�l�y n-�e orne�oi mis P�operty m perio:m Ine vmrk for wbich aV7Lealion is maae an01 mmpty vn�M1 the Stale ConVaelors Law 1827 RCW an0 296200A WAC. <br /> ;', 1 Z <br /> � �: �;'�..�z � <br /> ' �,. - — <br /> OwnedAltlhorizetl Agent Signaturc Date (Revised 6/2072) <br />