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� � <br /> PERMIT APPLICATION <br /> BUILDING/MECHANICALIPLUMBING/SIGNISPRINKLERIDEMOLiTION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br /> '7 -a `I <br /> SITEADDRESS: PROPEflTYTAXI� PE MIT# <br /> 03 6 ���r �.v Z66 8G 3 - 0 <br /> IEGAL lor new conslruction: ShoA PlaVsuhdivision Lol No._ (attach copy of long legal description) <br /> OWNER '.e �� Phone/E�mail S — 3 — q S C.. <br /> nddress 1, f {N w CnylSiatc2ip ` 1 �—�r � q8 �O <br /> APPUC.4NT:_Owner _Owner'sAgenl �Coniracmr ConlreclorsAgent ienant(m�;�e�ov�aa,imi��rmw.,semim.rmoa..�r.c�mao+.on�ninuspuca� <br /> CONTRACTOR ,�{ }� " (�a�h Slate Lic. # �k� ��City Bus. Lic. k <br /> Atldress ( /A ,,,W �j�J k .�G9r6� Phoneicmail � y� .�• a <br /> TENlr{J��ctl���AME � CONTACT FOR PERMI� <br /> K) Gt� Tv�O <br /> -t�,p`_ <br /> ( �j �7 � �v ('�M � Phone/[�mail ` — 367- Z 6 Sv <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK � <br /> Existmg Use of Building HEAT SOURCE: <br /> Proposed Use o�Bwtding Gas Eieclric Other <br /> Bwlding type. _Single Family _Duplex_To�vnhouse _Mulli�Famity _Commercial <br /> Type of GrojecL New Addition Remodel _Repatr_T.I. _Sign_Spnnkler_Demolitron Change of Use <br /> DESC RIPTION OF WORK(adtlA�onal space provided on fnc back): <br /> ��{i5a:a5 r«t S-��rtSS;ov. S�,S-4*��.n � t'Y(�l`'� •e .�-ye � -�- �YI;�n �1.o,-� �-� loc�.� e <br /> a�ne� �'-�� lae�e �o'z2�.eS�co�d=', k w; ��. ��P�.se b�;id �� '���(Qc�d � <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Typu ol PwjcrC _Naw_Addn _Altaratiai�Rapalr Typo u1 Projacl: _New_Addn _Alleralimi_Repair <br /> Show Num6cr(q)o!lixfares Show 1lumbcr(q)o/lirtures <br /> A/C-air handhng units Toilet <br /> � Porced ait syslems 6athlub <br /> Gas pipin9 Lavalory(wash basin) <br /> I Weler hea!er Shower <br /> Gas fireplace � Kitchen sink 8 disposal <br /> Gas ranqe Dishvssher <br /> Clothes Arver � Clothr.s washer <br /> Ranye hcod � Water heater <br /> Fxhaust fan Sink(scrvicelbarfmop/etc.) <br /> Heat pump � Backllovi preventer <br /> Und hcater ( U�inal <br /> � t3oiler Drinkmg Fountain <br /> � Reingeration � Floor drain <br /> Woodslove Grease tr:�p <br /> Uuctmg Roof drams <br /> Other Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM � Other <br /> � humbcr of Hcads I Other: <br /> i i�.��reliy cetlAy ihat I h;�ve�entl:mtl c.,mncd Ihu apptiwhon.ind Ynow!�e same to be Irue anU cnrrecl Ali piovis�onr.ol l.�w;an0 orGinnnce,govemmg i�is lype ol vmik wJl be cornp6ed <br /> vnlh wOeRicf sDCCGetl�^rcin of nCl t�e gronbng oi a Dermn tlocs nat 0�e,ume to give.ul�onry lo violaic ar canccl I�,o provisiun ol iny alher slale oi lowl law re9olabn9 constmclmn <br /> T�at I am au�horiiea�y o owner el i�i;prope�y 1:cedotm I�e wort lor whic�appl�calion i;mane ona I ccmply vnln Ine Stale CONraclars Law 10 77 RCW ana 796I00/.WAC i/ <br /> � � I� <br /> i V�/2�l' z01� <br /> OwnedA uriz J Ac nl Si�natuw Date /Revrsod J/107J; <br />