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PERMIT APPLICATION <br />BUILDING/MECHANICAL/PLUMBING/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 />SITE ADDRESS: <br />7 Fern ROGd <br />PROPERTY TAX N <br />'3l100403yoo <br />P RMIT p <br />/ -C.17� <br />LEGAL for nrw construction Shhof1__ _Lot No _ (anach copy of long legal desrnpbord ! <br />�Plat/subdrv5wn <br />OWNER I-Aa(q�kVrOA��suS Htfyrifs <br />Phone/E-rnadq?,S-29B-2`i2`j -� <br />Address 31n- Ill QL <br />CdyfState2tp <br />APPLICANT: Or _Owner's Agent _Ccotracar _Conlraclo's Agent aoaaeaietzramnr�ra'mne n.nn tomes-nnTc wmt <br />CONTRACTOR 4QLUI 1 l PO V"i <br />1,_`Tenantfmm. <br />State Lic #fin (kck L31 I Z- <br />D' Z. C,lry Bus Llc # <br />k fjs uv1 <br />ss C�(� Aecte10 1 � � Iv —A <br />Pm hone/Eaik'-zl—Z-1 ?—c' <br />r0 <br />TENANT BUSINESS NAME <br />CONTACT FOR PERMIT oet e h ct4c Tcd <br />PhoneJE mad q Zs-Z4d -2-11 L�1 <br />BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK j <br />Existing Use of Building HEAT SOURCE Y <br />Proposed Use of Building GaIX Electric Omer <br />� <br />Building type _ Single Family y� Duplex _Townhouse _ Multi -Family _ Commercial <br />T of project New Addition Remodel Repair T I Sin Sprinkler Demolition Change of Use <br />DESCRIPTION OF WORK (addthonal seam pmvlded on the back) <br />mew yplei-._.cA 'llnec� Z Car yq✓cty� <br />MECHANICAL PERMIT APPLICATION _ <br />PLUMBING PERMIT APPLICATION <br />Type of ProjecC'I-- New _Addn _Alteration _Repair <br />Show Number of fixtures 6 <br />Type of Project: New _Addn _Alteration _Repair <br />Show Number of fixtums <br />/VC - air handling units <br />Toilet <br />Forced au systems <br />I Bathtub <br />Gas pi jing <br />Lavato wash basin <br />Water heater <br />y <br />Shower <br />' <br />Gas fir lace <br />Kitchen sink & disposal <br />I <br />:as ,an a <br />Dishwasher <br />Clothes dryer <br />Clothes washer <br />Range hood <br />Exhaust fan <br />Sink servtce/barlino letc <br />Heat pump <br />Backflow preventer <br />Unit heater <br />Urinal a <br />Boiler <br />Drinking Fountain E <br />Floor drain I <br />Refrigeration <br />Woodstove <br />Grease trap5 <br />Ductrig <br />Roof trans . S' <br />Medical Gas <br />Other <br />SPRINKLER I SUPPRESSION SYSTEM <br />Other <br />Number of Heads <br />Other <br />I hemby cemly that I have read and e.ammed this app'ralron and knew me same to be time and wrred At nm,rerons of laws and cntmances govemng this type ut work wd he comp <br />wain whether specified hem. or notthe granting of a Penned does not presume to give aulhorlty ld violate or cancel the pmviston of any otter state or b-11 Law regulating mnyrodan <br />Thal I am avnisitp by the owner of this pe t eno t Ne work for whichapplication is and I mmply ventthe Slate Con'mttdrs Law 16.27 RCW and 296 2(1 WAC. <br />OwnerlAu on ed Agent Signature Date (Revised 9.17014) ,IZ <br />