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425-252-1666 c.m.heating 08:00:19 11-04-2015 1/2 <br />• . <br />t'thGME l Af'F'LICATION <br />BU(LDING/MECHANICALIPLUMBING/SlGN/SPRlNKLER/DEMOLITI�N <br />C1TY OF EVERETT PERMIT SERVICES <br />3200 Cedar St., Everett, WA 98201 425-257-881D FAX 425-257-8857 www.everettwa.org <br />'TEADDRESS; �'.� ��� ��� �� �PROPERTYTAX # <br />:GAL (or new construction: Short PlaVsubdivfsian Lot DJo. (attach �opy ot long legal description) <br />NNER {' � � �/r 1 O� S Phone/E-mafl 3�� -�3 �-as � <br />dress , � �����f�(,r1_ �1 Cily/State2ip L�v�.e�-�-� �f�i `�a�� <br />'PLICANT:_O�vner _O�vner'sAgent �Contractor ^Contraclor'sAgent TCf10f7I(mualp�+ideatetlerofc:nsertUomlhaourerlodorvcrhutilhetpa:.e) <br />)N7RAC70R Q, � �(� State Lic. #f�;� �'�` ���" Clt Bus. Uc. #Q��d <br />dross' jr'� �J��'� W� qg�O� Phone/Emall �-2r 259 L�l�l� <br />NAtJT BU51NE5S NAME CONTACT FOR PERMIT <br />��Ve, �25 25Q �►�to(o. <br />Phane/E-mall � � �m <br />UILDING PERMIT APPI,ICAT[ON coNTEta,cr Ptttce oF woRx ��y l.� <br />isting Use of Bullding HEAT SaURCE: <br />�posed U�e af Building Gas Electric Other <br />ilding type: _ 5ingle Family _ Duplex Townhouse _ Multi-Family _ Commercial <br />�e of �roiect: New _ Addition _ Remodel Repair T I Siqn 5prinkler Demolition ChanAz of Use <br />:SCRIPTION OF WORK (addition�i space provided on the 6ackJ: <br />�� � � � r . � I�. / <br />MECHANICAL PERMIT APPLICAT[ON <br />�o of Projuct: _Now_Addn �Altaratton_Rapair <br />Show Num6cr (#) of fxtures <br />A/C — air handlfna units <br />at <br />Woodst�ve <br />PLUMBING PERMIT APPLICATION <br />Typo of ProJoct: _Now _Addn _Altoration ____Ropatr <br />Show Num6er (N) of f7xtures <br />�►��FI -i�i <br />Greasa <br />sink & disposal <br />Other Medical Cas <br />SPRINKLER / SUPPRESSION SYSTEM Other: <br />Number of Heads Other. <br />:rehy certify that I have read end axaminad this eppGcation and know tha sama lo ba uua and caneci. All prnvistans at laws and ordinancea poveming ihis typa of work win 6o comp� <br />!h whelher apedfied harein or not Tha granting af a parmit dana nol prasuma to giva aulhority lo violale ar cancol the pmvision ot any ather stnle or local Ia�N regulaling construction <br />at I am authorizad hy the awnar of lhls propaRy ta peRorm tha work for which appGcation i� mada and i comply wlth the 52ate Cortlredars Law 18.27 RCW and 258.200A WAG. <br />. � <br />o aa �� <br />Nner uthorfzod Agent gn tura Dale (Revfsed 9/ZD14) <br />