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� � <br /> PERMIT APPI�I�ATION <br /> BUILDING/MECHANICALIPLUMBING/SIGN/SPRINKLER/DEMULITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 425•257-8810 FAX 425-257-8857 www.evere!twa.org <br /> SITEAD�RESS:n 1 � /� PROPEqTYTAXk ry��o J O <br /> // l <br /> LEOAL far rc i cansWction: Sho�PleVsuCdiNslon Lot No. _ (eltach eoOY ol lonp legal descdpllon) <br /> OWNER Y �' � S�c,�- Y.L��p ( Z pnonalE-mall �� Z O � 0��1 � <br /> AUdress 12'� C.�/[y�/ S/�'� N p �yVY� � S�2�U� <br /> CI ISInte2i <br /> APPLICANT:_Owner _OwnefsAgenl _Conlraclor Conlra[IOYCAponl TenBn��muapvwe�ieneralama�ruAomu�wmermmnoninNe�p�n� <br /> CONTRACTOR M UG,� Y I�-r�ti���� � Stetc Lic,p MOC/�P/ +'h .j,T(� Cil Bus.Lia BOS 3�a 3 S <br /> aedress �7f15 y��S�- SG Snv �.�.�' L, W�� �7S�Z4U �onelEmai f'3�'% . G7M • �..�, �� caw. <br /> TENANT BUSINESS NAM CONTACT FOR PERMIT <br /> PhonelE-mail <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORH <br /> Exlsting Use ot Building HEAT SOURCE: <br /> Proposetl Use ol Buildmg _ Gas Eieanc Otner <br /> Bwlding typn.: _Single Family _DupleK_Townhousa _Mulli-FamNy _Commercial <br /> Type of projed. _New _AtlJ�Uon _Remede� _Repair T.I Siqn Sonnkler Demolilion Change o(Use <br /> DESCRIPTION OF WURK(aJd;he�a�spaec proe�n.a�on mc Dueh): <br /> fr�dc l� � �k ��� wL..-� <br /> MECHANICAL PERMIT APPLI�ATION PLUMBING PERMIT APPLICATION <br /> Ty�eolProJecl: _Naw _AEUn _Allerotlon_Ropplr TypoolProJecl: _New_ Addn _/,Ilarnllan_Ropair <br /> S�ow NumEer(p)o//lrfuras Show Num6cr(M/n!1"�xfurcs <br /> A/C—alr hantlling umis � Toilet <br /> I Forced eir s slems Bethlub <br /> Gas pi in Lavalo (wash basin <br /> Watcr healer Showe� <br /> Gas fireplaCe Kilchen sink&disposal <br /> __ Gasrange Dishwasher <br /> Clolhes dryer Glulhee wxsher <br /> Ran e houa Wa1er heator � <br /> � Ezheua�lan Smk(sorv�celbai/mop/elcJ <br /> Heaf ump Dackflow reventer <br /> Unil heala� Urinal <br /> Dollcr Drinkin Fauntafn <br /> RoMgcrution Floor drain <br /> Waodslove Greasa Irn <br /> ____ � Ducung Roof tlreins <br /> omer Medical Gas <br /> 4PRINKLER / SUPPRESSION SYSTEM olhec <br /> NumbcrolHoods ___ Othef __ __ <br /> 1�embY U��V Ih:tl I hnvn m�d nnn er.�mrnnd IM�nppi,cafan nnd knew�Ae cnma Io ee Irue anU mrreel.nli prod�lan�of Inwe nnJ oNin�nma 9overninp Inh type.ol wnM vnn pe mmp'2J <br /> MI w1�el0el epetl/�M�emin nr nat ITe yrnnll�q o1 x permB tlam nw premme lo plve ovinoflty lu vblvb pr otnml t�a pmv4'on al anY al�cr nlnln ot locnl lnw 1lpulellny COmlNnron <br /> Thel I em aNAariied b�Ne ormer A Nls pmpC�ly lo perta�m I�awv�k fOfwlilN�DOflW110n Is maE!and I mmD�V wdA IAe Slnte Conlndors Low 1A 77 RCW and 79F 100�WAC <br /> ��f�� 1`� ' � - �.1� <br /> OwnedAulho�icad Agonl'Jignafure Da�e (Rewsed 3OO iJJ <br />