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PERMIT APPLICATION <br /> BUlLDINGIMECHANICALIPLUMBING/SIGR�/�PRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 425-257-8810 1=AX 425-257-8857 www.everettwa.org <br /> SITEADDRESS:���� ��� n/'� n � PROPERTY7AXp PER(IT; _ D <br /> !�-/ ' <br /> LEGAL lar nevi conslmQlon: Short PlaVsubdrvisron LaI No._ (attath copy ol long legal descrplion) <br /> OWNER �J�/�j,�� Phone/[-ma�l <br /> Address �J 03 �.,� City/StatelLp <br /> APPLICANT: _..Owner _QwnefsAgen( �Cont�aUar _CuntraclaYst.9em __Tenanl�m�,�v��+uc.,m,«mcaraeno-ommemN����aco„-o+:nm.sF:+=e� <br /> CO�TRACTOR � i State Lic :t �O� �,?�_ � Cily Bus. Lic ,Y <br /> Adtlress 2Z t Z y�� �l L ��il C�UsU� � �onelEma�l (j�fQ -/J T (� S <br /> TENA�N/T BUSINESS NAME CONTACT FOR PERMIT `��V�-�1'(/�(��/ 11;S�L' <br /> " ��y�^ ��2 �y��� PhonetE�mail�/l�� � 31,� �s� .y�s <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK Zr� "'7` <br /> Edsting Use of[3wltlmg HEAT SOURCE: <br /> Proposed Use of Bwlding Gas _ Electric Other_ <br /> Building type� _Single Family _Duplex_Townhouse _Idulti�Family _Commercial <br /> Type of projecC New Addition Remodel _Repa!r_TJ._Sign__Spnnkler_Demoldion_Change of Use <br /> DnESCRIIPTION OF WORK !ac'u,ncnal<F��c p�ovideCon c Gack ��� 5 ��-� rj fj-{yy� <br /> (%lYvt{,�SS �Gc��-cv i�L✓.�v� �G 4L tL� �o�^�- i'1? /�y' ' <br /> IZjfi2'Z� �T?1���G�.S �L'`S �o �� il�5� N �''��'�—r• <br /> :-r�' 3 ��:�I-''� ' � Iz F (L�-�,m, /�l <br /> �,�i � �o c,Z..c< � . /� �� k 1z �<i(�- �(Is w�f�''� R- <br /> MECHi�NICAL ERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type ol ProjecL• _New_Addn �Alteration_Repair Typo of PmjecC _New_AdJn _Alleralion_Ropair <br /> Show Numbcr(q)ol lixfures Show Number(d)ol lixfures <br /> AIG-airhandlmgurn�s I Toilet <br /> � Forcedairsystems � Balhtub <br /> ; Gas pipmg Lavabry hvash basin) <br /> � Water heater I Sho:,er <br /> � Gas freplace � Kilchen sink 8 disposal <br /> � Gas range � Dish�,vasher <br /> � Clothes dryer I Clolh�s washer <br /> Range hood � Water heater <br /> Exhaust fan Sink(servicelbadmop/elt) <br /> � Heat pump � Bactillow preventer <br /> Uni�healer � Urinal <br /> 0oiler i DrinY,�ng fountain <br /> I Refrigerahon � Floordrein <br /> Woadslov= Gre�se trap <br /> � Ducfing I Roof drams <br /> Other j taletlical Gas <br /> $PRINKLER ( SUPPRESSION SYSTEM otner. <br /> I Number of Heads � Olher: <br /> I R^_re�y cetl•�y�hal I I+ove reud ond e,�mined iEis app:2a:ion ana know ICe same io De we antl mrted FII proviswns cl laws and ordnances 5ovem�ng iMs iype ol work n+il Ue campl:e� <br /> wiln wnel�er specdieC here:n or nol ihe gr.nbn9 ef a pertn�CoeS net p:esume to gh�e aulnemy to violale ar cancel Ine prov:sion ol any olher slate or 1ou91law rCSulabng cansln:ct�on <br /> That I am authon:etl Oy�hc enner ot Inis pmpeny lo pedorm I�e work lor w�irl�apDhcotion is madc anG I wmpty wii�the SIaM CenlraCors Law 1827 RCW antl 256 2COA WAC. �� <br /> � r� ^/� � <br /> wnerlAulhorized A9eN Signaturo Dale (r^-vised 9?0131 <br />