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� <br /> PERMIT APPLICATION <br /> BUILDINGIMECHANICAL/PLUMBINGISIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St . [verett, WA 98201 425-257-8810 FAX 425-257-8857 www everettwa org <br /> SITEADDRESS: � PNOPERTYTA%p PE MIT <br /> GQ�\� S <br /> LEGAL lor new constmct:on Shon P�aVs�6Awiz�on 1 ol No (atlacn cepy ol iung ieqai descnOhon) <br /> OWNER P�one!E�niail <br /> AdOress GIy�51ate17ip <br /> APPLICAHT: ___Owne� __OwneYSAgent �Conlraclv __ConlractoYSAgeni Tenantimni;�ae•ai�^ercicc��o�ir�c,,m�,,.�,��•oo�,.�n„r��,�p,,c�i <br /> CONTRACTOR �V� t� `C�U� Sta!e L�c k� q F Gty �us I.ic a <br /> Add�Css y-�� �„ -- S��pry�p+.�yti V,J� P�onc�[ma�l �a -rj - l,� —� � <br /> TENANT BUSINESS NAME CONTACi FOR PERMIT �� \����1J ya5-J�lC4- <br /> /��CZ��N�"��_�.�Z�-S �.x.�CC�V��'�`I Cl�.°S�Y'� �..�ph� '�13�1 <br /> P�onc�[�mail '���p G <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK �30��rnrn _ <br /> Ex�sung Uce ol Bwltl�ng _v f�c r.t.'� HFA7 SOURCE <br /> Proposetl Use ol dwltling�,�„�o(�neh.e �.���.\ � __ Gas Elecuic__ Olher__ <br /> Oudtlmg rypc _Single Famtly _Duplez_Townhouse _Mani-famdy ✓Commeraal <br /> T pe of pro ect New Admlwn Remodel Repa�r T I Sign__Spnnkler__Demoi�non Change ol Use <br /> DESCRIPTIONOFWORK�aa�.nona'soacopror�dcoonrneDac�l Ih6�0.\� � � �.'r'��S\v�w4\� m °s'�I'vca\ <br /> �—av.�:4��.�Ot��S� '���9C�0+�' � Cecw��c�. cAoc.rc� svcoepl�on Cr�u�..K^ <br /> MECMANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type ol ProJecl: _New_Addn _Alteratlon_Repair Type of Projoct: _Now_Addn _Altoratlon_Ropair <br /> Show Numbci(M)ol liifures Show Numbw�IJ ol lirNrn� <br /> NC-av hanai�ng units To�lel <br /> Forced an s slems Oathlub <br /> Gas � mg I.avatory(wash bas�n) <br /> � Water heatcr �� Shower � <br /> Gas Lrepiace � K�ichen sink 8 d�spusal <br /> Gas ranaz i Uishwashcr <br /> Clothcs tlr er ' Clolhcs V,dshef <br /> Ranye hood ' Water he�iter <br /> Cxhausl lan �� S�nk Iscrv�m�ba�rmop/elc� <br /> Heal pwnp I Backllow Vrevenler <br /> Uml hCd�cr UnnTl <br /> Hoiler Unnkin Founlain <br /> ' Refn cration i floordram <br /> ' Woodslove � Grease Irap <br /> Duchng � Rool drains <br /> Olher I Metlical Gas <br /> SPRINKLER I SUPPRESSION SYSTEM � O�lier <br /> Numbcr ol Hcads � Other <br /> i�ereEy cehrty��al I hnve read nnE e.emmed i�ls apeMw�mn antl enow ine same lo Ce ime en�<onecf All p�ovmm�f cl ln�rf anE artl��encoti Bovemng��n typa ol woil v.�9�u compneC <br /> wn�wT<I�er specmed�ciem or nol t�e grummg c�a i�e�ma Exf na�preeume ro gne oNnnrny io�iaiate o�u�cel me Fmvu:on o�an�o��er s�ato a�bc���uw regviaunq ronfiroqion <br /> tnol I oT auinonrca o�me owrer ol my¢io¢enY��`1`^"w��+lne xoiA kr wn.rn appbce'�an n meGe onG i tomply wit�t�e Slnie Co�'�s:to�e law IB 71 ftC N an0:i6.004 WAC <br /> �IZ <br /> ��+'R,e,,.9m.. \l4�/�, <br /> OwnorlAut�oriiod�gonl SlgnaWre Date IRev�se01:07]) <br />