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PERMIT APPI_�CATION <br /> BUILJING/MECHANICALlPLUMBING/SiGNISPRI��KLEf�JDEMOLITION <br /> CITY O� EVERETT PERMIT SERVICES �p -- 3 0 �/ 2 <br /> 3200 Cedar SL, Everett,WA 982C1 425-257-8810 FPX 425-25;-3857 www.everettwa.org � <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM C..1- <br /> SITE ADDRESS: D ,^ G PROPERTYTA%N PER IT# <br /> ���� • Y Ll..h �� <br /> LEGAL lor new constmction: Shotl PlaVsubdivision Lnt No._ (attach wpy of long legal descnption) <br /> OWNER � � �e � Q�r(�� � � � Phone/E�mall G� CU 1'1� �i V i �,O . G C m <br /> Address � �� � � �e. �\ � �Q City/StatelZip l.� y!T'C l��� <br /> APPLICANT: Owner OrrnefsAgent �Contractor Conlrac�or'sA9em Tenanlcm�:iP�o.�aaekr.e�ai�o�:emnommo�,.�+e��oeo�oMmma.ca�m <br /> CONTRACTOR FLi� ��'r �� G L 8 I Lic.# F�;7�•� I ���<<l COE Bus.Lic.# <br /> Address �Q �j� �� �v T � k��J�w� 1���� Phone/Email �� GZ � 'F9,�U0.1�i 4'�C <br /> TENAN-T7BUSINESS NAME CONTACT FOR PERMIT <br /> ` l -�( / l ` ` ��'� Phone/E�mail 1 l� � TU Q i� .�e� <br /> BUILDING PERPJIIT APPLICATION CONiRACT PRICE OF woRK ZD 0 '— <br /> Fxisting Use of Building � HEAT SOURCE: <br /> Proposed Use of Building �'l ' YV�TL-A'^ \'��e- Gas �_ Electric_. other_ <br /> Building lype: _Single Family _.Duplex_Townhouse _Mulli-Family x Commercial <br /> Type of projecl: New _Addilion _Remodel _Repair_T.I._Sign_Sprinkler_Demolition_Change of Use <br /> DESCRIPTION OF WORK(add�fionai space provitlea on tne back): �N'�5 w '��-' ` <br /> ti2e�l�ce 3 cx°, :�-� ���I ro��,p <br /> lk��% -���� �Q��.e -�av�r�, e.. <br /> NIECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of ProJecl: _New_Addn _Alleralion_Repalr Type of ProJacl: _New_AAdn _Alterallon_Repalr <br /> Show Num6er(q)o/lixfures Show Number(#)o/lixtures <br /> =( A/C-air handling units Toilet <br /> Forced air systems Bathtub <br /> Gas pipinq Lavatory(wash basin) <br /> Water heater � Shower <br />_\ Gas fireplace Kitchen sink&disposal <br /> Gas range Dishwasher <br /> Clothes dryer Clothes washer <br /> �� Range hood Waler heater <br /> Exhaust fan I Sink(service/bar/mop/elc.) <br /> Heal pump Backflow preventer <br /> Unit heater I Urinal <br /> Boiler I Drinlcing Fountain <br /> Refrigeration Ploor drain <br /> Woodslove Grease trap <br /> Ducting Rcof drains <br /> Other Medical Gas <br /> SPRINKLE� I SUPPRESSION SYSTEM Other: <br /> P'umber of Heads Other: <br /> 1 hem�y cerirty Ihal I�ave-.aC�ind examined'his applicolion antl knmv Iho samu lo Oa liuo and eonect.All provisions ol laws and or7inances govemin8lhls type o�work wi9 Co comp6ed <br /> viM1�v.Tcl�e�speciletl herein ot noi.The granlinA ol o permit tloes nol pretumo to Oivo oul�onty to Wolala o�cnn<el l�o pmvision oi on7 oiher sla;o or local law reBul�ling consW dion <br /> Tlial I am aulhonzed by ILe mvner o/l�is pmpe�y Io pedmm ihe woM ior which apP���otlon ie made antl I compH N'nh t�o Slale Contractors Law 1827 RCW nntl 2°fi.200A WAC. <br /> � � i ? <br /> �^5^�' �� I <br /> OwnerlAYlhodt d A9ent Signature � �� ~ o ie �L� (Frvised&'2012J `C 7i <br />