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PERpAIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CiTY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett,WA 98201 425-257-8810 FAX 425-257-8857 www.evereltwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITEADDRESS;� _ I / V0.0PERTVTA%p PERMZtt I _ DO� <br /> � �lCt �r-c-� N/ <br /> LEGAL'c�nr.w construction: Shoh Platlsubtlivision Lot No._ (adach copy ol long Iegal tlesrnption) <br /> OWNER {j.i�h �.��n.��u.�hf:Jt�.z:.�.�s �. � PhonelE�mail �/ -'� - � <br /> Atltlress �Gi t��- i� �' k� CitY/StatGZiP (��/-Q�.t.-{� WII " /U �� <br /> APPLICAN�O�mer Owner'SAgeni CO(IIfBC�OI �CO�IfdC10I5A9E111 �TfOdO(l�us�pm:daakN.e�olcvnse�JhvmMecenetloCor.oA�nTofpaze) <br /> /. <br /> CONTRACTOR / � v . � • .:it , L&I Lic.# COE Bus.Lic.Y <br /> Adtlress � ,�j�7��11 �L �S[. �� ,+ j 7 £��� Phone/Email S- - Z - a � <br /> TENANT BUSIN SS NAME CONTACT FOR P�RMIT � �" <br /> ; `�c��<<C' blSl ('I�c • ce�,. (�l�,�f��-c— Z�=��— <br /> Phonel6mail Q�i - 2 <br /> BUILDING PERMIT APPLICATION CONTRnCT PRICE oF WORK 7�; �zz �` <br /> Existing Use of Building �h r5 �-' /-�-fl �.�-�� � HEAT SOURCE: <br /> Proposed Use of Building_�.�I�-�-'---�- _ Gas_ Eiec�nc Other _ <br /> Building type: �Single Family _Duplex_Townhouse _4lulti-Family _Commercial � ' <br /> i <br /> T pe of pro'ecl: _New Addition � RemoCel _Repair_T.I._Sign__Sprinkler Demolition �•Chan e of Use <br /> DESCRIPTIONOFWORKfadCitionalspareprovitledonthe0ack): r ' _ <br /> Ti.t�i-< «J 120u-�c ����-r ��t-t_ 'YZY Gt�z-^ �,..-=-J •�j�-u—e� ' <br /> C L� <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> TypeofProJect: _Hew_Addn _Attoratlon_Repalr TypeolProjecl: _New_Addn _A�teration_!tepalr <br /> Show Num6er(N)o/lixlures Show Number(xJ o/flxtures <br /> � NC-airhantllingunits Toilel <br /> Forced air systems I Balhtub <br /> Gas piping lav2to (wash basin) <br /> Water heater Shower <br /> � Gas fireplace � Kitchen sink 8 disposal <br /> � Gas range � Dishwasher <br /> Clothes dryer Clolhes�vasher <br /> Range hood Waler heater <br /> Eahausl fan Sink(servicelbaUmopletc.) <br /> Hcai pump � BackBow preventer <br /> Unit heater Urinal <br /> Boiler I Drinkin Fountain <br /> Relrigeraticn Floor drain <br /> Woodstove Grease lrap <br /> Ducting Rcof drains <br /> � Other Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM other: <br /> Number of Heads Other: <br /> I here�y cenM ihal I hom mad ontl examinea Ihis app�kallon nnd Xnow I�e same to ba Wo anG wrtect A�1 pmvisions of la�vs anG oNinances goveming INa lypo olxork n+A Oe complied <br /> wah�Mether specifmE�crein or nol.T�o prantin8 0/a pertnil tloee nol presume lo qive om�ony to�iolala or cancel l�o pm��sron ol nny other sta�e or local Ww reBuWiinp conslrurPor <br /> That I am auNor11e0 Cyt�e owner ol lhis propeM�a Petlortn Ihe woM torw�ich eppliceibn le ma0e anC I compry wl�I�o Stalo CONraclore Lew 10.P RCW anE 298.'.00A WAC. <br /> . - � /.. /'j : • i <br /> Y i7r=��1�� -�" �]� 'J/)J <br /> i �' . t�-�i/Y'�-'.� !' //%(/-' /�i" I �-- <br /> �0 Cl/AuthorkeU Agenl SignaWrc Da16 (Re�75etl6/2077) �I�. <br />