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� � cRMIT APPLICATI0�1. <br /> BUILDING/MECHANICAUPLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 -425-257-8810— FAX 425-257-8857—www.evere wa. rg <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM T01 PM � 31 2 <br /> SITE ADDRESS: 3A09I3roade:q':\crnue,F�rrct�,\\':\ PROPERN TA%p PERMIT M <br /> OOc7G002300001 Q '0 <br /> LEGAL for ne�:v construction: Short PlaVsubdivision Lot No._ (attech copy of long legal Cescnpuon) <br /> OWNER Clil'-EI11S071.Lf Fhnne�E-mail <br /> adaress =�Zy KL'CIClR,1�7i N100 Cdy�State'Zip h:\'ERE'f'f,�1'.19N2111 <br /> CONTRACTOR Hc:dlr.msfcrCo. L 8 I Lic #��H•`\l'T••211fiQ0 3c HEA'1'7'C'009D.\ <br /> 4dtlress <br /> 1'.O.Aox 12CA.('�vnalion.l\'A 98014-12(H PhoneiEmailalc.gNS-3247 heuttranrl'rrl''_a nol.com <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> tinci�J Sccw•ilr:\Jminisln�Uun.E�crcll FicIJ OlTice Hichsvd tiinnrma m•'1'am�1cClmkcr <br /> � Phone%E-mail �25-HAF-32J7 henliransfr�lr'a�xol.rnm <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK O0. 0 <br /> Exishng Use of Building OITcr HEAT 50URCE: <br /> Proposed Use of Bwlding U��j�� Gas Electric Other <br /> �uilding type: _Single Family _Duplex_Townhouse _Multi•Family _Commercial <br /> Type o(projeci: _New _Adddion _Remodel _Repair T.I _Sign_Sprinkler_Demolition_Change of Use <br /> Descript�on of Wofk(addiGonal space provided mr the Uatk): <br /> Have you started working wilhout a permil? _YES NO <br /> MECHANICAL PERMIT APPLICATION PLUMdING PERNIIT APPLICATION <br /> Type ol Project: _New_Addn _ Itern�ioi _Repeir Type of P�oject: _Naw_Addn _Allerntion_Repair <br /> Show NumGer(#)o/fixtures Show Number A of fixfurcs <br /> A/C—air handling uNis Toilet <br /> Forced air systems Balhtub <br /> � Gas ipinq Lavato (wash basin� <br /> � Water heater Sho�,�er <br /> � Gas 6re lace Kdchen sink 8 dis osal <br /> � Gas ran e Dishwasher <br /> Clothes dryer Clothes washer <br /> I Ranqe hood Water heater <br /> � Exhaust fan Sink(servicelbar/mo /etc.) <br /> �. I Heal pump Backflo�.v preventer <br /> I Jnuheater Urmal <br /> 3otler Dnnkinc� FouNain <br /> Refnneration Floor drain <br /> i Woodstove Grease tra <br /> I Duclina Rooi drains <br /> I Other Medical Gas <br /> SPRINKLER / :iUPPRESSION SYSTEM Other: <br /> I Number of Heads I Other: <br /> I Pereby cettity thal I ha�e reetl and eKamined Ihis appucetion enC Know.the seme to be Irue and correU.All provisions of lava and ordinances governing <br /> niis type ol+�rork��ill be compl�ed�wtn�vhether speafied herein oi not.The graNing of e permit does not presume to give aulhonry tu violate or cencel <br /> IhE provi5i0�O(00y OlhEf SlBte Of 10[01 Id'.V Iegulaiing COOSfNcti0I1 Or ihB pef}ofntailt0 Of ConStNdioO.That I 001 ONhOnzOQ by Ih0 o�.�nef ot th'�5 pfoaerty <br /> lo peiform �wrA for efiich applicalion is made and I comply�+nth the State Contraclors La�n�1827 RCIV antl 296200 4VAC <br /> �� � �25� �� �z <br /> OWi IAulhmizedAgenlSignature Daie (Revrse024011r <br />