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� • <br /> PERMIT APPLICATION <br /> BUILDING/MECHpNICALIPLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.evereriwa.org <br /> SITEADDRESS: PaOGER7YiAxu P�'�Q —OO� <br /> � f <br /> LEGAL for new consimction: Shotl PlaVsu6division Lol No._ (allach copy ol long Icgal tlescnplion) <br /> OWNER � � L. O ✓� PhcnNE-mail Q � <br /> Address � 1 I'� City/StateRip � pi �,/'.� Ct b <br /> APPLICANT: Ovmer _Ovmer'sA9enl Con(raelor _Coniraclor'sA9m1 _Tenan��m�v��o�;aoaie;mraiconsemi�om;noo�.,�r�r.om�•�oK�.,mns�acel <br /> CONTRACTOR Moe,^ P��^r h'�n � Stale Lic u Moen(�/����,3 J U aey a�5. uo. tt 053(03 S <br /> c. vas �bo 5�s6o <br /> AdUress 175�5 �-/1�S F 5�= Sno �n��5� G1 ��f (�Z�U Phone/Email j��.} /yu,.,p/u.�,�i� , c o� <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> PhonelE-maJ <br /> BUIL�ING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> ExisUng Usr of Building HEAT SOURCE. <br /> Proposed Use of 6;!ilding _ Gas Eleclric_ Olher_ <br /> Build�ng lype: _Single Family _Duplex_Townhouse _Multi-Famity _Commercial <br /> Type of projed: New Addilion __Remotlel _Repair____T.L _Sign_Sprinkler_Demolilion_L'hange o(Use <br /> DESCRIPTION OF WORK(adddional spacc prov�ded on tnc bacx): <br /> �^ ) �C�� �� �c.L � 11C��� UG�.�.rC l 11 �ct.L h+�l� <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Typeo(Projecl: _New_AAdn _Alteration_Repair TypoofProjecl: _New_Addn _Alleralion_Repair <br /> Show Num6cr(H)of/ixfurCs Show Numbcr(dJ ol lixlures <br /> A/C—av handliny units -�oilet <br /> Forced av syslems I Ba�htub <br /> Gas piping I �.��atory (wash basin) <br /> Waler healer I Shower <br /> Gas(replace I Kilchen sink&disposal <br /> Gas range I Dishwashcr <br /> � Clothes dryer � Clothes v+asher <br /> Range hood Walcr hea�er <br /> � Exhaus�lan � Sink(serviceNadmop/e�c.) <br /> Heal pump � � Oack(low preventer <br /> Unit healer Urinal <br /> Boiler I Dnnkmg Foun�am <br /> Relrigeration � Floor drain <br /> Woodstove � Grease Irap <br /> Uucting I � Roo(drains <br /> Other � Med�cal Gas <br /> SPRINKLER I SUPPRESSION SYSTEIII � o�her: <br /> NumberofHeads � Olher. <br /> I lu:retiy ceiUty uia�I have ieod antl exarnmetl tl�,oppSwhon an�knovi I�e s�me lo Ee Irue and correct All pmvr.ion.ol lias antl ortliwnces yovercng Inis lype oi woik wi'I Ee comp're�l <br /> vnRi viN�Urer spcoied hew�n or nol Tlie ryanLn9 nl a petmA�ocs nnl presumc l0 9n¢aulhonty lo violate or<ancel�he pmvisicn ol any olher;late o�IOWI lav�requlatinq mnslnrtlmn <br /> Thol I:im aulho�rsetl�y Ine orvner olllvs propetly lo perlorm I�e wo�k lor vihich nppl¢alion is maCe anA I cCmply wJ�NC Slate Conbaclors taw 19 77 NCW anU 27F:OOA WAC <br /> �,�-�I / ��u- � - 3 - � S � <br /> OwnedAutl�orizad Agenl Si�jn�durc � Dule Q7nv�,5�U 9/207J� <br />