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PEl�MIT APPLICATION <br /> BUILDINGIMECHANICAL/PLUMBINGISIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar SL, Everett, WA 98201 425-257-8810 FAX 425-257-8857 vnr,nv.everettv�a.org <br /> SITE ADDRE55: PROPERTY TA%p PERh11T# <br /> `6 I F r ,e n� L,I K � S - <br /> LEGAL lor ne:�ccnslrucliun� Short PlaVsuttlrvaion Lo1 No (atlach coDY ol long le9al�esonplion) <br /> OWNER l[l/ yy�0 ' ��t pi y� I�LL PhorelE�mail <br /> ACtlress y S � �u � City/Sta!el7.�p <br /> APPLICANT:__Gwner _Ovmer'sAgeN __Conlreeior _Conlractor'SFgnnt Tenani;mosivo�n=aaieicroionenirtent:oa.��enaaow�� n��espare; <br /> CONTRACTOR ��Q ��r„r,kSo n wl L L� State Lic * City B;:s. Lic " <br /> �Jdiess ��Z p0.yt,(Vy� (yJ �Fn �•�/ Phanef[rna:l <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> J�-� SZ lM` V-�S Phonc/E mail <br /> BUILDING F'ERMIT APPLICATION CONTRACT PRICE OF WORK ��T� . tJ� <br /> Esisimg Use of Building HEAT SOURCE�. <br /> Pr000szd Use o(Building Gas_, Eiecuic Omer <br /> Budding lype� _Single Fam�ly _Duplex_Tov+nhause _Multi-Family _Commerual <br /> Tyae of pro�ed. Ne:+ Addtlion Remodel Repair_T I. _Sign __Scnnkler__Dem^Itlion Change of Use <br /> DESCRIPTION OF WORK (sd.y;�onaisp:,cepr��vedonrrebacal <br /> G�S �:�;v�i rar �711� � QV�`'J <br /> �J <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> iype ol�rojc�t: _New_AdJn __Al(Cralion_Repair Typo of ProjecC _New_Adtln _Allcration_Repair <br /> Show Num6cr(q)ol lis(urce Show Numbcr(dJ o/lirfums <br /> I NG -ar hantlling unds '� Toi�et <br /> � Forced air systems � [iathlub <br /> — ' Gas piping � Lavamry(v:ash basin) <br /> � Water heater � Shower <br /> � Gas lireplace I Kilchen sinF.Z disposal <br /> Gas range � Dish�vashcr <br /> � Clothes dryer � Clolnes v+ashar <br /> Range hood Water heater <br /> [xhnust(an Sinh(servicel6admopletc) <br /> Heat pump � BacY,flow prevenler <br /> Umt heater Urinal <br /> �oiler i DnnY.ing Fountain <br /> � Refrigeralion Floordrain <br /> Woodstove Grease trap <br /> � Dudmg � Roo(drams <br /> Other Med��cal Gas <br /> SPRINKLER ! SUPPRESSION SYSTEM Other. <br /> Number o(Heads � Olher. <br /> Ihere�yceNfyt�allhavereada��eaam:nedl�isappSuVionantlknow'�esamelaCeVueanticerrect AllpmvisionsollawsanCoi�inance,govemingihlstyFeolworkx�Obecompfe� <br /> wfn Hnel�cr spc.�l��cd Oe�cin or nol Tlle grunbng al a pmLn Gtts net D�csume lo grve dulnoidy lo via101e or wnccl In:promsion ol any o:�cr stale or IOail law re9ufaVng consimtlion <br /> Indl I am autnoalc�by Ihc ov.nel ol t0is pmpCny lo perterm Ihe wotk for v.hrth aCGI'.cauon is maUe antl 1 fAmply���,�p I�e Sldte COnIraC.Jrs law 1 A 27 RC W anC:9G 200A WAC. <br /> �!/ v ` I ' Z7� � � <br /> Own / lhorizetl Agenl Signalure Date ;Revised 34013) <br />