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'u F vage 3 ot 6 ,015 08-04 05 70 18 (GMT7 �9884000393 From �ieGo�a� Sh�eitls <br /> PERMIT APPLICATION <br /> BUILDING/MECHANICALIPLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY Of EVERETT PERMIT SERVICES <br /> 3200 Cedar St., cvereri. VVA 96207 425-257-8810 FAX 425-257-8857 w�n,w.everettwa.org <br /> s�TenooRess�4910 BLACK FOREST LANE °PovenrvrAxx29053100308400 PERMITM <br /> b9- 005 <br /> LEG/ll h��ncv.canu[r..cUoo bP�:M1 Plabs�.iD�+mb.pn Lot No ianae�' �ruLr'�!loce�byal des.r,p:,n:. <br /> OwrveraLLOYD SMITH v�cneti-n�;n425-252-7544 <br /> >��.�,s4910 BLACK FOREST LANE �;,iT,,,•.iZ,�EVERETT, WA 98203 <br /> APPLICANT. �mu: �.N-ersA:ler _ Cerlra.m� � ��mvacterSAger; ieaant:-�uxvo.w:nr.sia�oc>�:rv,,,r.,«•.�e�iuno.�,n����„a:po�: <br /> CONTRACTOR WESCO sta�e��c.z WASHIES97iOB ;,�.�y Bus. �.ic.u41349 <br /> a�a�•_s53909 196th St SW �r,o�_r�,,,,n80039&-4fi63 <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> .lMli�C^:C JVCLI l f/i��!�-Llvf JI�N'.-��f jyff.\'+L W.11:l�`I.1 <br /> F�illn E4Tdii <br /> BUILDING PERMIT APPLICATION CONTRAC7 PRICE OP WORK ��74 2`' <br /> Enservy Use ol Budding Res HEAT SOUR,CE <br /> Pr000setlUse Itlm Gas Eiea�ic � �a:e� <br /> Bdild�no;ype ��,ngle ram�k Dup�e o�rmhouse Famdy � ^ommerpal <br /> T� ot ro etl� Nzw Aedition Remooel Re air � .I. Si n 5 rinkler �emoiiuon Chan e oi Use <br /> DESCRIPTION OF WORK;etl:i,eorra/specep�ov�aedtntne�eck) <br /> INSTALLING AC <br /> MECMANICAI PERMIT APP�ICATION PLUMBING VERMIT APPLICATIUN <br /> Type ol Pra�ttt _New_Addn � IteraGon_Repair Type of Project _New_Add � Iteration_Repair <br /> ShowNumber p ollirluies ShowNomber tllo/liihiras <br /> WC—d�r hantlhn untls ' Todel <br /> i Forcad au s stems gq�h�i.ry <br /> � Gas i in � Lavator �.vash basinl <br /> Waterhen7er ' Showe� <br /> Gas M1re lace � �' K��tc�en sink& dre osal <br /> Gas ran e D�shwasher <br /> - Golhes dryer ' !'lothes washrr <br /> Ran e hood Wa:erheater <br /> Esnausttan - Smk �senncelbar,mo �ett.l <br /> Heal um ' 6aGkticw revenler <br /> � Umt�eater ' Unnal <br /> �� Bo�ler Dnnkin Founiain <br /> � Refn eretion Fioororain <br /> Wocdstove � Grease tra <br /> Duciin Rooi dra�ns <br /> � Giher Medical Gas <br /> SPRINKLER / SUPPRESSIOH SYSTEM Other <br /> Number o!Heads � Other <br /> I nrn>by cerrty Inrl 1 M1nva m.�tl antl euimrni!Iq�s appycapnn anC wnow Ibo same i<De Ive ar.�co+el .L'oro�nsqns o'hvn ane ok�r'ance�s pm.. ,�g tbqlype c!vmrv r-mbe ro�np <br /> +rm+'M1etncr spevne��wnin or���.ine p�nnong of a ce^nrt Joes no:prewnm m gve a.rtnm���lo�no4'e ur�ixe�L'��e oonun o'�nY,�Ver vate o�bcai t,w reOuN'�np a�v,vorcr <br /> ��a��nm auM�orrzeE uy Vie awne,p•nxe prvpnrty i�a pa�arn Il�n naM fur v�ncM1 n[�h,:aUori w inaJu a�M I cmnplY��'r.e Sta�e Co.T�uCon Lar.1 e,+?PC'h anC�96:JJP N4' <br /> JenniferCovello ---•---.--_.•�—.--•�. &3,�s <br /> OwnulAUMorlieOAgeM5lgnature :. ' Cat=_ rP.e�.rsnJ9:urii <br />