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�t'��.. �l� • • s-7� ����� <br /> tv� ,. <br /> � , , <br /> �.,:.,- '�;:: -'' _i....� \,��: <br /> PERMIT APPLICATI�N `-' <br /> BUILDING/MECHANICALIPLUMBlNGIS1GNISPRINKLERIDEMOLITION <br /> CITY OF EVERETl'P�RMiT SERVCCES <br /> 3200 Cedar St,, Everett, WA 98201 425-257-8810 FAX 425-257'-8857 www.everettwa.org <br /> S17L ADDRESS: [�+� PROPERTY TAX# T D <br /> � l : , d�% �4 v {�Uf �U�? ? 7�C � � `� <br /> � <br /> I.EGAL for new construction: Short Plat/s�bdivision Lot No. (attach copy of long legal description) <br /> � <br /> owNER r`(��-� � '`rl C PhonelE-mall � �— ��� �- ���� <br /> Address��� `�� b�J f�� eJ�'✓� Clty/StatelZip ,`V ,�e '�/ � ��� � <br /> APPLfCANT;_Owner �_Owner's Agent �CORffflCtOf _COf1tf8C�0I'9 AJBItl ^Tef18hS(musl pmvide a lerier of consent fmrn[he ovmer 1 o In lhe space) <br /> CONTRAC70R 15 ' rr�n f � [� Stete Lic.# fl (Z 1��� � � City Bus.Lic. �i�� <br /> Address '� ���`, � Nf�`) `e�nL������ 7 j" Phone/Email����/ �j7� •- �;�Jt _ <br /> TENANT BUSINESS NAME CONTAC7 FOR PERMfT <br /> PhonelE-mail <br /> BUIL.DING PERMIT APPLICATION CONFRACT PRICE OF WOR � C? <br /> Existfng Use of Building HEAT 50iJRCE: <br /> Proposed Use of Buifdirtg Gas Etectric Other <br /> Building type: _Single Family _Duplex_Townhouse _Multi-Family ,_,Commercial <br /> 1- pa of ro'ecf: New Additian Remodel Re afr T.f. Si n Sprinkler Demol(tion Chan e of Use <br /> QESCRIATION OF WORK(adddional space provided on fhe back): <br /> �n5l-r�.�1 dut��l�'S� �P,/� ��M� W f��'l �IN�D U n��or ti+.Px�.�,5� <br /> MECHANICAL PERMIT APPLlCAT10N PLUMBING PERMIT APPLMCATION <br /> Fype of ProJect: __New Addn �Alteratlon_Repair Type of Project: _New�,Addn ,_Alteration,,,Repair <br /> ShowNumber #)offixfures ShowNumber # offixfures <br /> A/C—air handlin units � Toflet <br /> Forced air s stems Bathtub <br /> Gas pi fn l.avato wash basin <br /> Water heater Shower <br /> Gas fireplace Kitchen sink&disposaf <br /> Gas ran e Dishwasfier <br /> Clothes dryer Clothes washer <br /> Ran e hood Water heater <br /> Exhaust fan Sink service/barlmop/etc. <br /> Heat um Backflow reventer <br /> Unft heater Urina! � <br /> Boiler Drinkin Founfain <br /> Refrl eration Floor drain <br /> Woodstove Grease fra <br /> Ductln Roof drains <br /> Other Medical Gas <br /> SPRINKLER/SUPPRESSION SYSTEM Other: <br /> Number of Heads Ofher: <br /> f hereby ceriify that I have read and exarnined th3s appllcafion and knour the same to be frue and correct.All pravislons of laws and ordlnances goveming�hls lypo ofwork will be comp <br /> with whether specifiad hereln or not.The granting of a permlt dnes not presume fo gNa au(hodly to vIo(ete or cencel the provlslan of any otherstele or tocal law regulaling consiructlon <br /> That I am euthorized by the ownerof this properry to pedortn ihe work forwhfch appiicaUon fs made end I comply with tha State Contractors Lew 18.27 RCW and 286.200A WAC. <br /> t/� �' <br /> Owner/Authorized Agent gnature Oate (f?evised 9/2014J <br />