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D e c, 17, 2�? 1 � 8; 14AM N o. 1241 P, �
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<br />PERMIT APP��CA?`ION
<br />BUILDING/�VI�CHANICALIPLUMBING/SIGN/SPRINKL��R/D�MOLITION
<br />C1TY OF EVERETT PERMIT SERVICES
<br />3200 Cedar St., �vereft, WA 98201 �125-257-88� 0 FAX 425-257-S857 www.everottwa,orc�
<br />ITE ADDRESS;
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<br />PROPERTY TAX #
<br />LEGAL far new wnsirucfion: Shoii Pi�Usubciivisloil IAl N9.
<br />OWNER !� 4!`, a„ G" �. >.r; � c�'' F'honp/E-meil �
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<br />APPLICANT'J�, Owner
<br />CONTRACTOR �•�� `�
<br />Addtess `�;a� ;�4 ��,c;� �~:.
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<br />°�+.:Y.�„� ,�' S,,'�.._. f,ity/StatelZi�
<br />_ Owner's Agent _ Cu�rtraclor _ L'o�llracloi's A�C�1l
<br />�. �� c> � �-���.t�� �,.�,: 5tate Lic. tt
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<br />(attacf� ropy of long le�al description)
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<br />_�,•ti �%�;' l� k � �, � � �, �.`�
<br />-I�c111�11 (mu5t piovitle et Initer uf conyanl fro�n Uie oNner lo elo wrork fn Uie space�
<br />.� �i��;i;���l_"_-�:��§-��'6::'..�::L:ity Bus, Lia �l;•, ���' '�;�_,
<br />IPlwnu/Eitiall t,.,�.,.y �_....µ;•.�.,._� � ,��,..,...
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<br />NTAGT FOR PERMIT
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<br />BUI�,D�TiG PERMIT APPLICATyO�I CONTRAGT PRICEOF WC
<br />Exisling Usa of �uilding
<br />Proposed Use of Bulldirt�---- .............:�_. . _
<br />f3uilding type: � Single Famiiy _ DEiplex _l�owntiouse _ MUiti-FHrT11€y __ ConllilArCfal
<br />Type of project: f�iew Addition KerrlvClHE Repalr _... T-I. _ Sign _Sprinklor
<br />DESCRIATION OF WORK (auuulonal space provlded orr llie hack) ;
<br />MECHANICA,I� P�RM1T L1PPLiCAT�ON
<br />of PYoJeCt: _New�Addn _Alte�atlon_Repalr
<br />Show Number (/t) nf flxfures
<br />A/C — a!r t�andllny units
<br />Forcad alr s slams
<br />GAs � ifl4
<br />Water heater
<br />Gas fireolace
<br />Ranye hoad
<br />Exliaust fan
<br />9
<br />HFA'1' SOURC�;
<br />Gas � ElvctfiC Ulftuf
<br />of Use
<br />P�UMBINf PERMIT APPLICATION
<br />Type of Project; _New _Addn _Altsration _Rupaif
<br />Show Nurlll�ur (kJ of fixfures
<br />Toilet
<br />8athtu�
<br />Lavator (wasfi basi��)
<br />Showor
<br />Kltchen sink & dfs osal '
<br />Dlsl�washer
<br />Clothies wastier
<br />W�ter heHter
<br />Sir�k (service/k�arhno /etc..)
<br />eackflo�v orever3ter
<br />Vnil r»al�r Urinal
<br />Dpilc�r Drinkin Fountjin
<br />Refrlc erAti�t1 �loor drain
<br />WoodstUve Grease tra
<br />Ductin Roof cirains
<br />Other .,....,._.._ MedicaE Gas
<br />SPRINKL�R / SUPPRESSION SY3TEM Uther:
<br />Nurnber of Heads Q�hnr:
<br />I heraUy cenity Ilist I have read and oxomEncd thia c�pplication and knaw ltue �:n�nr. lu br. (n,r.:,ud t:unr.�:t. nll piovlsions uf Isws enU oiUlnsncea goveming Ihla lype ol vrofk tMll bo compl
<br />wiln v.he(ner apaclnad heraln oc nol. Tho �r,mting <�f:} p��irnil d❑��s nal piesume lo glve yulhoriiy io viofela or esncel the provleion ol any other eWte or local latv regalating com:lniclion
<br />1 hat I�m aulii, �zr,d t�y �h�� own��i uf Il�is pri,pe�y !o pbrtorm lha work lor �vhlch epplicatfon le mado and I comply with tho Statc Contrnr.tor:; I;m tn,27 RGw,���d 2e�s.znnn wAc.
<br />I :.::. .., '�:•', � � V.�
<br />O�,yner/A EhUYized Apenl Si�naturo atP �� `(!{6vlsod 9/2014)
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