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� ����o�� � <br /> PERMIT APPLICATION SEP Z 0 2012 � <br /> BUILDINGIMECHANICALIPLUMBINGISIGN/SPRINKLER/ OLITION <br /> CITYOFEVERETTPERMITSERVICES ��"��' `� 'k�`�S' <br /> 3200 Cedar St., Everett,WP.98201 425-257-8610 FAX 425-257-8857 www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED Ff20M 8 AM TO 4 PM <br /> SITEADORESS: PROPERiYTNIN ,� P�RMITn <br /> �k �'Z Cc�lbi re or� � - � u � i � os � ��o 2 <br /> , <br /> LEGAL lor new wnst�udion�. Shotl PlaUsubdrvision Lot No_ (allach copy of long legal tlescnption) <br /> OWNER � �/1 fa' wC�L i- l- � n Phone�E�maii <br /> Adaress <br /> � ��f Z �� N C— ! ��l��4 �{ CitY/Stale2ip 1.�%Jr�tl�'�. v i 1 Lz LVA 1 � �� Z <br /> APPLICANT:_Ovmer Owner'sAgent �Contrectar Contraclor'sAgenl Tenant�m�>iywae�brro¢m�.emno�nea...re��oaa+.onmcesoac�� <br /> CONTRACTOR Clr.�- � '{ �: �t c '✓i S L 8 I Lic.# �-�f�R i f.�71'�13FI COE Bus.Lic.# <br /> :�ddress �� Z�� `� /�C � f��4 S 1 K�c��m���r l���L�� PhonMEmail �� S `f ,�i�� 1 �='��`} <br /> TENANT BU INESS NAME CONTACi FOR PERMIT �{-LS T CSS � V�'�� <br /> ' (:rueSt t'x�'L' Sfore ' <br /> �/ 1 S( C�• Phone/E-mail ,�C'Vi N Q ����f N <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK �F f� r_i�r.-� <br /> Ezis6ng Use ot Building HEAT SOURCE: <br /> Proposed Use of Building Gas Elenric Otner <br /> Buildmg type: _Single Family _Duplex_Tuwnhouse _Multi-Family Commercial <br /> T e of ro'ecC New Adddion Remodet Re air T.1. Si n 5 rinkler Demolilion Chan e of Use <br /> DESCRIPTIONOFWORK(addrtione�spacepmv�deeonthebacN): � � �/ <br /> (�i5fc� l � C.i ' 11CG, - tl �u {oiio��uTi' !� �IpT �C� iv / c�' l�j 'vi <br /> klECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> TypeofProjer.l: _New_Addn _Alleratlon_Repair TypeolProject: _New_Addn _Alteration_Repair <br /> Shorv Number(aJ ol lixfmrs Show Number(N)o/lrfwes <br /> NC-airhandim unds Toilet <br /> Forced air s stems Bathtub <br /> Gas i in Lavalo (wash basin) <br /> Waler healer Showef <br /> Gas fireplace Kitchen sink 8 dis osal <br /> Gas ran e Dishwasher <br /> Clolhes tl �er Clolhes washer <br /> Ran e hood Water heater <br /> Exhaust tan Sink(service/bar/moplelc.) <br /> Heat oum 6ack8ow reventer <br /> Umt heater Unnal , <br /> Boiler Dnnkin Fountain <br /> Refri eration Floordrain <br /> Woodstove Grease trap <br /> Ductin Rool dra�ns <br /> Olher Metliwl Gas <br /> SPRINKLER / SUF•PRESSION SYSTEM Other: <br /> Number of Heatls Other: <br /> I licreby certdy Ihal I M1ave reae an0 examinetl Ihis applKnlnn anE knav Ue fame lo Ue Lue en0 coced.M pr�,niona ol lew6 antl ortlnencee povemmB���s y0e ol woA wil be mmpleC <br /> �nlh�Melher aprcifed herein or nol The Brenting nl e pem�E Ocef nol presume la O��e nuthoMy to vaWte u fancel Ine V���sron of eny oI�M slale or brel law reBulabn0 wnsbutlun <br /> 7 hal l am authonze0 Oy Ihe c.mer o111�if propMty to petlorm I�e Hork for whx�epp��.elwn le ma0e atA I comOb��n Ihe Stele Conlracta�s Lew 1 B27 RCW nnC 298 2�DA 1VAC. <br /> � <br /> �..4I–\����,,.�A—.1�—� �� I J � , �. ,� <br /> OwnerlAuthOr�zedA�S�SignaWre � � Cale (Revised6R012) Z <br />