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i � <br /> PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/D�MOLITION <br /> CITY OF EVERETT P�RMIT SERVICES <br /> 3200 Cedar St , Everett, WA 98201 425-257-8810 FAX 425-257-8857 v✓ww.everedwa.org_/ � <br /> � � a <br /> SITEADDReSS:� � PROPERTVTAXn PE IT� <br /> � 2v i � v� �,1 �N.�-� �a � - o <br /> LEGAL lor new conslruction: Shon PlaUsubdivi ion Lot No (altach copy ol long leqal descnpllon) <br /> OWNER � (� �-�/1 P�one�E�mail �O�j Z�i �7� <br /> AOdress 71 DI l`�- L • �^� l /-J`l � City/Sa�e/Zip ��q� II L� l�J� �B�I� <br /> APPLICANT: O:•�ner O':�ne�sAgenl _Conlracior _ConlratloiSAgent _Tenanllm�stprc.�aenieceroic�mmurommoownermro..oM�+•.`u:pace7 <br /> CONTRACTOR �E I C LL � l:(7��I • Siate Lic # Cily �us Lic. # Gj 3�5 <br /> Add�ess 2��2 /v � >"r� � • ' Phone/Ema�l ./f7tl Zb / bt� <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT S1T��� Va���� <br /> ,Jq��J � �1/�4�( e+-(-� -� --�C p�r2---�7 <br /> �� �� PhonelE-mail �� ' J8 ' CJ/JJ ( <br /> BUILDING PERMIT APPLICATION coNTRACT aRice oF WORK f6Sm��a <br /> Eaisting Use of Bwlding EI'��7'� HEAT SOURCE�. <br /> Proposed Use of 0uildmg C� � 9 li i C O �'I�i� Gas_ Eiectnc_ Other_ <br /> Buildicg lype: _Single Family _ uplex Townhouse _ylulti�Famity _Commercial <br /> Type ol pro�ect. Ne:� _Addition ✓Remotlel _ _Repair_T.I. _S�gn__Sprinkler____Demohtion_Change of Use <br /> DESCRIPTION OF WORK (acamonai space p�wided on rne bac�): <br /> ��D -tti�o xl�v a .�.�. �/�4�r�r�S' � � ��,�.�A�� ��r� Fo�" <br /> i�E�U (�^��1�1T <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMI"f APPLICATION <br /> Typc ol ProjecC _New_Addn _Attcralion_Repair Type of ProjecC _New_AAdn Alteration_Rep��� <br /> $fmw Ilumbci(MJ oI fixfures Show NumbCr(qJ ollirtu�es <br /> A/C—air handling unds I Toilet <br /> Forcetl air sysiems I Balhlub <br /> � Gas piping '7j Lavalory(wash basin) <br /> Water heater I Shov+er � <br /> Gas fireplace � Kitchen sink 8 disposal <br /> Gas ranc�e Dishwasher <br /> � Clolhes dryer � Clothes v�asher <br /> Range hood Waler healer <br /> Exhausllan � � � Sink(service/badmop/etcJ <br /> Heat pump � Backliow preventer <br /> Unit heater Urinal <br /> 6oiier � Drinking Founlain <br /> Refrigerel�on Floor drain <br /> Woodstove Grease lrap <br /> Ducbng � Roo(drains <br /> Olher Medical Gas <br /> SPRINKLER I SUPPRESSION SYSTEM Other <br /> � NumberofHeads � Other: <br /> I here�y cendylndl I�ave IeBd'JnC Cxaminetl IMs app5wlion and knaw ihe same Io Ee Ime en7 coirecl All provisions ol laws and otEinanres goveming Ihis type ol wolk wJl be comp4etl <br /> wnh w�e�her specdled nerem or no�.Tne granling ol a permn does no�presume lo give aumority to vmlale ar cance��he F�ovislon ol any cmer s�a�e or tocal law regula�ing cons�ruqion <br /> Thal I am am�onzetl Ey�he owner el l�is praperty lo peAorm I�e work for�Mich appliwl�on is matle and I eomply wuh I�e Slale Lomraclers Ww 18 17 RCW anG 296 200A WAC <br /> � �r �l J� . z� zo�� <br /> Owncrl uthorizc AgenlSiynaWre Dale (RevisedJ?077) <br />