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PERMIT APPLICATION <br /> BUILDINGIMECHANf�ALIPLUMBINGISIGN/SPRINKLERIDEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everetl, WA 98201 425-257-8810 FAX 425-257•8857 wavw.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM T04 PM , � O`JZ <br /> SITEADDRESS: �� � e �C� PROPERTYTA%N PERMITk <br /> �lo � 9 l��e o 0 00000 oa zo -o3g <br /> LEGAL br rew mnsWCLon SMn PlaUsubd�vision lot No_ (attaUi copy of lony legal aescnotion) <br /> OWNER V �-�l�Vi L�L. anonME�mad yZ$ ie(o , ,°° c e�c ao��«Yt <br /> �a,�ss �(� z5 ��. c y Gry/State2ip ����e�i w A 8 zo8 <br /> APP�ICANT: OKner �OnneYSAgen1 Co�iractor _Ca^Iraeto�sl�genl _Tenant�o�sic•o.ae.ic��oim�sennomu+eo.�n:ote.wn�..ee�w:�i <br /> CONTRACTOR O 2- YN Il'lr� L 8 I Lic.p CGc Bus. Lic# <br /> Mdress Phoneffrn�d <br /> TENANT BUSINESS NAME CONTACT FOR PERMiT ,f ZS 77� 9SQ p <br /> 5rt9 �v,ll[n `T <br /> PnoneiE-mail I � � P �7���`��f���«� <br /> BUILDING PERMIT APPLICATION CONTRAC7 PRICE oF WORK <br /> Eaisting Use ol Buildmg S I HEAT SOURCE� <br /> Propased Use at Building �b GLtQ.Ll1{Q� Gas_ Eiectnc__ Other_ <br /> Build�ng type 1�Sinqle Family _Duplex_Townhouse _Multi-Family _Comme�cial <br /> T pe of pro ect. New Addition _Remodel X Repair T.I- Si n__Sprinkler_Demolilion Change ot Use <br /> DESCRIPTIONOFWORK�addnonarspaceo���dedonrneback) <br /> A-(a.cullli c(c, G�S occ vr�d' r�e_�r 1tiu `lo^ o-f -{tu s/o� l��hZ! -1-� Gro✓�c. ��� <br /> �,-oje�+ ��,Volvcs s�ab� (iliv�q -itnE ekia�vt� �lo�+ ��ih..�0..zu o F1ltc lCLndsli� l�,,� <br /> Iq,c�fdiNq ti. new ��-iR�im�q N�f:.0 lZyo.ti! -I�,(r. sl�c�-.�re+ni��11q Wa.t,l w��ll c��sf�f- o-f <br /> S 51-2c1 iUi cU -+�rV�b¢r� W �ebac S a ✓�.57�'1' Q �OaCE . <br /> MECMANICAL PERMIT APPLIC PLUMBING PERMIT APPLICATION <br /> Typc ol Project: _New_Addn _Alteration_Repair 7ypo of Projetl: _New_Adtln _Al�eration_Repair <br /> Show Number(tl)of firlures Show NumDer(tt)o!�rtums <br /> A1C-air hantllm un�ts Toilet <br /> Forced au s stems Bathlub <br /> Gas p�p�ng Lavalo �wash baslN <br /> Water healer Shower <br /> Gas fireplace Kdcnen sink 8 drsposal <br /> Gas ran e is�washer <br /> 'ol�es tl er t�es washer <br /> Ra e hood Wa r heater <br /> Eahau lan Smk rviccroadmo lelc.) <br /> Heat pun Backllo revenler <br /> Und healer Unnal <br /> Boiler Drmkin Poun in <br /> Reln eration Floor drain <br /> Woodstove Grease vap <br /> Dutlin Roo�drains <br /> Other Medical Gas <br /> SPRINKLER / SUPPRESSION SYS Other: <br /> Number of Heads Other: <br /> I OereCy cenrty Ina�I Oave reaG anE eummeC Uiis aFD6wlion and Ynow Ne same to Ee true anC carted.M D��Wons a�Wws an0 ommances goreming Ihis lype otwork v.+A ee wmpbeG <br /> w^s wheV�er spea8ed AereT or nol.me grantuig o�a permil Caes nol Crewme to pive auNonry to volate oremcel Ne D���a�ol any aNer state or bfal Lrv regut��ng canslrudion <br /> 1Tai I am ouNoriEeC Ey Ne oxner cl tnisO�PQM�o Oerlorm Ne woa forwti�a074e�tion ls maEe an01[omCh�+N Nc Sla:e ConVaaors Law IB 27 RCW an0 296100A WAC <br /> C�l -Y�Zv�GL� �(u�IrL �� <br /> OwnerlAuthorizetl gentSigna re Date (Revisetlfi20121 <br />