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PERMIT APPLICATION <br /> BUILDINGIMECHANICALIPLUMBINGISIGNISPRINKLERIDEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org n'I <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �U`- �"�'��Z' <br /> SITE ADDRESS: VROPER7Y TAX N € <br /> St S�-C�k �v2ce w(� `t82v � P1�1� l'J— Ol <br /> LEGAL lor new conslmction Short PlaVsubdrvision Lot No_ (altach copy of long legal tlescripbon) <br /> OWN.'=R ,yn"�.5 ��- � Z �3 `�' Phone/E-ma�l <br /> Address (,�, ry�}�c��1 (.t�cj �`�'r y�I City/Slate/ZiP ��(\{� W 7`1 D � <br /> APPLICANT:_Owner Ovmer'sAgeni Con�ractor �Contracror'sAgenl _Tenant�m��s�v�o��aoakr.eroico�semimmmema,e�mao..o•k��me:oa:.i <br /> CONTRACTOR "�J S eC�(1 (�� � 'td�(-e`� L&I Lic.# COE Bus. Lic# <br /> Address '�j��� ��l ��Ej � �}�. ��0 ��?��\�' `C1�3� �honcl[mal 20�-�1�3- 33 <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT �_-��3_033�,1 <br /> . I�t�`15'�`�l„ (� � <br /> 1�1G'� � Phone/E�mail � � 1;.,j s�C 'CC��� <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK (ll�J-uU <br /> Ezisling Use of Building �nfS- a(��l 1 HEAT SOURCE�. <br /> Proposed Use of Building �\�}��`�� �`� \— Gas_ Eiectnc_ Otner_ <br /> Ovilding type�. Single Family _Duplex Townhouse _Mulli-Family �Commercial <br /> Type of pro ect New _Addition Remodel Repair T.I. Si n 5 rinkler Demolition Chan e of Use <br /> DESCRIPTION OF WORK(addmonal space provided on tne bacx)t " <br /> InSt�i� �o�5ti-,,� ��u�,,b�� -C�+- ��� �roJ��cQe ��..�`. � ..sh -�,x��s l��c� . <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> TypeofProjecC _New_Addn _Alteration_Repair TypeofProject: _New_Addn Alleralion_Repair <br /> Show Number(N)o/lixfures Sbow Number(#1 0/fixmres <br /> � AIC—air handhng units I Toilet <br /> � Forced air s slems I BathWb <br /> Gas pipin Lavato (viash basin) <br /> Water healer Shower <br /> Gas fireplace Kitchen sink&disposal <br /> Gas ran e ' Dishwasher <br /> � Clothes d er I Clothes washer <br /> Range hood � Water heater <br /> Exhaust fan r� � Sink(servicelbaUmopletc.) 2 tloc�'�' <br /> Heat pump 8ackflow preventer n�- <br /> � Unit heater I Urinal <br /> � Boiler Drinkin Fountain <br /> � Refrigeration � Floor drain <br /> � Woodstove Grease trap <br /> � Duclin I Roof drains <br /> Other Medical Gas <br /> SPRINKLER ! SUPPRESSION SYSTEM Other. <br /> j Number of Neads � Other. <br /> I heie0y cerlJy It�al I have read an0 eaamined IIuS appliWlion���tl Anow Ihe same lo Ge tme a:�ccnecl iJl V�ov:sions ci!aws Ond Otdm]nces 9ovemmp I�is rype ol work wdl Ge compLe� <br /> veVi wheiher specifie�M1crein or ool Ti�e qrnnbnB ol a pMmil does nol pmsome lo&�'e au@onl�In violale or wncel l�e pmvision ol any ot�er slate or local�ar�regulatmg consVvct�on <br /> iinv I am aWhoriletl by Ihe ovmer ol ihrs pmpetly lo pedwm Ihe vrork lor whKh app�'���on a matle end I comply vnth t�e Slate Contraclors Law 1827 RCW anC 29G.200A VlAG <br /> ,.�. f� - l�] - lZ <br /> � Date (Revised 6QOt2) <br /> OvmedAulhori d gent Siynatum � <br /> SPe c�rne�c�e� appl�ca 2� r� <br /> ___ ----_.. ------ - > �_F°1 <br />