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/ _"_-- _ '"_ " I <br /> ' - r n � • I ��. <br /> � <br /> � PERMIT APPLICATION <br /> BUILDING/MECHANICALIPLUMBING/SIGN/SPRINKLER/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 /> I SITEADDRESS� � � , _ PROP�7YTAMp_'L _03 _� PERMIT�rD y�OD <br /> �. �f � <br /> ILEGAL for new conslruction: Shorl P�aVsuCE� sion Lol No._ (atlach wpy ol iong legal tlescriplion� <br /> ` � i <br /> OWNER ' Phone�E�mail � �'J - 2 Z-�.3LS Q��J',2 f . ' <br /> Address 2 3 `� sr S� City/Slatel2ip ,t, � I <br /> APPLICANT: Owner OwnersAgenl /`Conlraclor CamracloYSAgeN Te02A1�maHpro.Wu�eaeiolmnseMlmmlMovnerlaaowaMlnUwspau) � <br /> CONTRACTOR �-. � State Lic.# ��j ur- ZLiry Bus. Lic.8 I <br /> I AOOress �7 �� p3 r� � �L ��Q.� (/a. ��� Phone/Email �Ily� /�� ��. I <br /> I TENANT BUSINESS NAME CON?A�QR PER�YIIT,' <br /> �} C!4a.plr�-� <br /> � PhonelE�mail 36c}9LL-�,Sl� btN �;�� <br /> � BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK f 50 I 'S1 •,'I� ! <br /> , Exis�ing Use ol8uilding ' HEAT SOURCE: I <br /> !I Proposed Use of Building �eti:�C..,�1.� Gas_ E�ectric other <br /> I Building type: _Single Family __Duplex�Townhouse _Mulli-Famiiy _Commercial ' <br /> � Type ol project: New Addi�ion Remodel Repair_T.I._Sign �� Sprinkkr_Demolition_Change of Use I <br /> DESCRIPTION OnF�0WORK(adertiona�space providedcn�hr back): ' <br /> �LuJux Me✓1 flwn houo+-• � �veN�- Q�,00 •. . ..� ; <br /> IMECHANICAL PERMIT APPLICATION "' PLUMBING PERMIT APPLICATION II <br /> Typa ol Projetl: _New_Addn _Aileratlon_Repair Type'of Pro)ech _New_Addn _Alteralion_Repair ; <br /> Show Number(p)ol flxtures Show Num6er(p)allirtures I <br /> A/C-air handling unils Toilet , <br /> Forced air syslems Bathlub <br /> ( Gas piping Lavalory(wash basin) <br /> Water healer I Shower <br /> I Gas fireplace Kitchen sink 8 disposal � <br /> Gas range Oishwasher � <br /> � Clolhes d er Clothes washer ; <br /> � Rang�hoad a ter I <br /> Exhaust fan � Sink(serviceNz:;rnnp/etc.) ' <br /> � <br /> Heal pump Backllow Hr.-venter , <br /> Unit healer Unnal <br /> Boiler Drinking Fountain � <br /> Relrigeratiun Floor drain � <br /> Woodstove Grcase ira <br /> Ducling ( Rool drains <br /> Other Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEIVI other: I <br /> Numbero(Heads Other: � I <br /> I�crt6yRNfy Ihal I�evc rcaa and ecamineC IAis eppleatmn and know t�e snmc lo be Ime anC co�n.AO pmvi:.ians ol laws evd oidinances goveming this rype a/wod�n7�e mnplicd �I <br /> wrJlwtip�erspeufiea�erelnotnol.TltegrantinqolapetmiiaoosnotpresumetognoautnorMyloWolalearwnulNepmvisionolanyotnerslilewloWtlawrtgulalingWnslrvqion ' <br /> Thal l am am�onzeE Oy Na owner of Nis pmperty to petlortn i�e work�a which appiication is meEe anE I campry wiN tqe Slale Conl2tlori Law 1827 RCW an0 2961WA WAC. <br /> ��.�,.� � 3- 13"a°iy ' <br /> wnerlAuthorizad Agen� Date (Revised 9R0f3) <br /> L_ ' — '__ —�.__. .�_..—__— .".— <br />