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� , :� � � <br /> PERMIT APPLICATION <br /> BUILDINGIMECHANICALIPLUi�IBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar 5t., Evereri, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br /> SITE ADDRESS: PROPERTY TA%N PERMIT i <br /> 3 1�+►-c� t,�: o -.'7� -03 -a� 0 - <br /> LEGAL for new conslmction� Shotl PIaUs�bdi sion Lot Nc._ (atlacn copy o�long le9al descriphon) <br /> / � <br /> OWNER Phone/E•mail �- ZZ�y3`S �f� / A . <br /> AAEress z 3 �� Sr S I. City/Slale/Zip Z � <br /> APPLICANT:_Owner OwnefsAgent ontrador ConlractofsAgent TenantlM�.+siP.ovmaeianaroimnsemimmuwow�ncaawax�nobsosu� <br /> CONTRACTOR C..-. State Lic.# {Tj L �I.C,ily Bus. Lic. # <br /> FOAress 17 �� b3 r� � N(., V}[y�J�.. ' (,Itl. � P�onelEmail �li.ri / ;�. <br /> TENANT BUSINE55 NAME CONTANCT FQR PERnAIT <br /> a�r:,.�Ca.,.�p�>�-N <br /> Phone/E-mail 3�'�z2-' ,5�� bt/ ��,� <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK I � �� •b`j <br /> Existing Use of Building � HEAT SOURCE: <br /> Proposed Ue-e o(Building �Oa���1.� Gas_ Eledric O�her <br /> Building type: _Single Family _Dup�ex�Townhouse ._Multi-Family _Commercial <br /> Type of project: New Addilion Rertaodel _Repair_TJ. _Sign_Sprinkler Demolition_Change of Use <br /> DESCRIPTION OF WORK(addrtional space pmvided on tne back): <br /> �(�4�. RL�✓�Dw�'1�p�tni— � �ot�- 4dG��tuoo <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLfCATION <br /> Type ol ProJect: _New_Addn _Alteralion_Rapair Typo ol Project: _New_Addn Alteration_Repair <br /> Show Num6cr�M)oI fixfurcs Show Number(N)o/�riums <br /> A/C-air handling unils Toilet <br /> Forced airsyslems Bathtub <br /> Gas pi in Lavatory(wash basin) <br /> Waler heater Shower <br /> Gas fireplace Kltchen sinh 8 disposal <br /> Gas range Dishwasher <br /> Clothes dryer Clolhes washer <br /> � Range hood Waler heater <br /> Exhaust lan Sink(service/bar/mop/etc.) <br /> Heal pump Backftow prevenler <br /> Unit heater Urinal <br /> �oilcr Drinking Founiain <br /> Relri eration Floor drain <br /> Wocdstove Gr=ase trap <br /> Ducting Roof drains <br /> Other Medical Gas <br /> SPRINKLER I SUPPRESSION SYSTEM other: <br /> Number of Heads Olhec <br /> i <br /> I hereby cenity I�al 1�ave reae antl examineE Ihis uppllwLon and know Ihe same lo be Irue nnC cortecl.AA provisions ol laws entl aNinances goveming I�is IyDe al work wJl De comp!kd <br /> wd0 wi�clher specilieE�erein ar not.Tlle grenling ol a pCrm�Ooes not przsume togive Put�vrity lo vio�al0 or Cencei I�e provlson ol any other slale a local law regulatinD to^sirudion <br /> Thal I am aut�or2eE by Ine ovmei ol t0is propeny lo pe�ortn Ihe work br w�ic�appliwtbn is maEe anC I compty wil�I�e Sla�e Com�aclon Lew 1B 47 RCW aM 2%.i00A WnC. � <br /> c�—' �'..�i A/ �13 ���, � Z. <br /> ���l�f <br /> wnerfAuthorized Agent�ignature Date (Revisetl J/2073J <br />