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F <br /> � <br /> PERMIT AIPPL.ICATION <br /> BUiLDINGIMECHANICAUPLUM�iNG/S1GN/SPRINKLERIDE1VIOl.IT1C}N <br /> CITY O�EVERETT PERMIT SERVICES <br /> 3200 Cedar St.,Everett,WA 98201 425-257-881 q FAX 425 257-8857 www.everettwa.arg <br /> APPLICA710NS AftE ACCEPTED FROM 8 AM Tb 4 PM <br /> SIT€ADDRESS; � �� PROPER'(Y TAX# PER�M"IT� ��� <br /> S [z� �e,ve� 3��d. on a'3q oo4�eo9o� G1,�v I O <br /> LEGAL for new canstrucfion: Short Plat/subdivision Lot No. (attach copy of long legal description} <br /> OWNER �V����v !" •vAOZ. PhoneJE-maii <br /> Address $124 �e�/1 �1��. ��.�►e�I' CflYlState/Zip <br /> APPUCANT: Ovuner �Ovuner's Agent �Contractor Contractor's Agent �,TQI18ItY(must provide a Ietler of consant hnm the oxner ro do wodc in 8ie space) <br /> CONTRACTOR C� � L&I Lic.# COE Bus.Lic.# <br /> ddress Phone/Email <br /> TENANT U S N M CONTACT FOR PERMIT �Q�•en Ce u� d� <br /> PhonelE-rr�il �QU�'�CtltOJS1�JI�COM[a��./1$f <br /> BUILDIN6 PERMIT APPL.ICATION coNtw►cT PRice oF woaK 1 5 0 'o� <br /> Existing Use of Building 5�1� HEAT SOURCE: <br /> Proposed Use of Building S�Q Gas Electric Omer <br /> Buiiding type: �.Single Family _Dupiex Tawr�house _Muiti-Fam�ly _„_Cammercial <br /> T e of ro" New Addition Remodel Re air T.I. Si n S rinkler Demolition Chan e of Use <br /> D�SCRIPTION OF WORK(additional space provided on the back): <br /> R���a�,a,�� �'o �totafi'on ci�nfi'e�• : ma�.. s�aH'S �o�(� to.M.�O(�o�,.t , nna� �t�nad <br /> S�b.J� taq+�l�a�t � v � � � <br /> MECHANICAL PERMIT APPLICATION PWMBING PERMIT APPLICATION <br /> Type of Project: New Addn Aiteretfon_Repalr Type of Project: _Navr Addn Alteration_Repair <br /> Show Number(#)of iJxtures Show Number(#)of fixtures <br /> A!C—air handli� units Toilet <br /> Forced air stems Bathtub <br /> G�g i � Lavato (wash basin <br /> Water heater 5hower <br /> Gas fire lace Kitchen sink&disposal <br /> Gas ra e Dishwasher <br /> Clothes d er Glothes washer <br /> Ran e hood Water heater <br /> Exhaust fan Sink servicelbartmop/etc.} <br /> Heat pump Backflow reveMer <br /> Unit heater Urinai <br /> Boiler Drinkin Fountain <br /> Refri eration Floor drain <br /> • Woodstove Grease trap <br /> Ducti Roof drains <br /> Other Medicai Gas <br /> SPRINKLEI�/SUPPRESSION SYSTE Other: <br /> Number of Heads Other. <br /> 1 hereby cartiry that I have reatl and examined fhis apptic&tion end know the same to be true and correct.All provisbns of laws and ordinances goveming this rype of work wili be comptied <br /> vrith whether specitfed herein or not.The pranting of a permR does not presume to give authority to violate or cancel the provfsio�ot arry other state or bcal haw regulating construction <br /> 'that I am authorized by the oxmer of this propsAy to peKorm the work tor which appiicetion is made and I comply witfi the State Contractors Law 18.27 RCW end 298.200A WAC. <br /> ,, 2 S Zo� <br /> OwnerlAuthorizod Ager�t S re Date (Revise2f�8�0�,� <br /> � <br /> �Z � <br />