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0 IS(NA 0 <br /> PERMIT APPLICATION <br /> BU ILDI NG/MEC HAN ICAL/P LUMBI NG/SIGN/SPRI NKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br /> SITE ADDRESS; PROPERTY TAX# I PERMIT#M I -01 I <br /> LEGAL for new construction ShonPlatisubdivision— Lot Noj <br /> (attach Copy of long legal,escoption) <br /> OWNER 1LU%ll 1pnone'lE-,TaislkM <br /> Acidres0n,"41"l, -10 icitpStateZp t1jere"'-s- WII, <br /> APPLICANT:—Owner Owners Ager;) Contractor Contractors A int Tenant --pm-'e� 'tw w th.sowcc <br /> CONTRACTOR jti IState Lic.#1k <br /> n*JSQ)Q City Bus Lic.# <br /> Address t,ucL 't'wlm 4kqla" CMS-4 lPhone/Ernail 411.5 lq1q <br /> TENANT BUSINESS NAME CONTTACT FOR PERMIT <br /> LAr'&\ <br /> PhoneiE-rnaii (�-115-1 kk SR(A q <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK SbtIS— <br /> Existing Use of Building HEAT SOURCE <br /> Proposed Use of But'iding Gas Electric Omer <br /> Building type: Single F mil —Duplex_Townhouse _Multi-Famity _Commercial <br /> ,Type of project: New Addition Remodel —Repair , T I. Sign_Sprinkler_Demolition Change of Use <br /> DESCRIPTION OF WORK(additiona)space provided on the back)! <br /> :r — — a <br /> 2——V 0 r" t'M/ -ill e - . <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: New,Add n Alteration Repair Type of Project: New Addn Alteration Repair <br /> Iteration <br /> Show Number l'kt�0�ft Show Number(#)of fixtures <br /> airair handling units Toilet <br /> Forced air systems Bathtub <br /> Gas piping Lavatory(wash basin) <br /> Water heater Shower <br /> Gas fireplace Kitchen sink&disposal <br /> Gas range Dishwasher <br /> Clothes dryer Clothes washer <br /> Range hood Water heater <br /> Exhaust fan Sink{service/bar/mop/etc. <br /> Heat um Backflow preventer <br /> Unit heater Urinal <br /> Boiler Drinking Fountain <br /> Refrigeration Floor drain <br /> Woodstove Grease trap <br /> Ducting Roof drains <br /> Other Medical Gas <br /> SPRINKLER/ SUPPRESSION SYSTEM Other: <br /> Number of Heads Other <br /> i hereby certify that I have read and examined this appiscatl:o�)and know the same to be true and correct Ali provisions of laws are ordinances governing this type of wtXX wil be comp <br /> with WrietherspeffieVerern or n, Thet presume oes hot preSue to give authority to miate or cancel the provision of any other state or local law regulating consituction <br /> that I am authorized this pro to,PO mite worItf,'(which plicaon is made and I comply with the Slate Contractors Law 16.27 RCW and 296.200A WAG <br /> 0 <br /> Owner/Authorized Ag*nt$ignaWe 'I,/ 4 Date ;Revised 912074) <br /> V <br />