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� � <br /> PERMIT AF'PLIC/�TION <br /> BUILDING/MECHANICALlPLUMBING/SIGN/SPRINKLER/DEMOLITI�JN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettv:a org <br /> a - 1-1 <br /> SITEADDRESS: PROPERNTA%tt P h71T# <br /> O Z � <br /> LEGAL lor new consiruciion�. Short PlaVsubtlivision Lot No.� (atlach copy ol I..ng legal tlescnption) <br /> OWhER u, PhonelE-mail ��� �g ,U� <br /> Aedress ��, CitYlSlate/Z�p [� P; <br /> APPLICANT: Ovmer Owner'sAgenl _Ceniraclor _ConlractorsAgeni _TenaN�m.:.ic'a�,��o�io�.ie:aiw�sen�im�,;noo.�xr,aavweMminnspa:�� <br /> CONTRACTOR O.C' ) e, iN.11� / Stale Lic.# � � ���(� Gity Bus. Lic # <br /> Atltlress I 3 � �J� O jr,l(/ ����. � ��G!%7 PhonelEinail�d'y35->sss <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Phcne/E�mad <br /> BUILDING PERMIT APPLICATION coNTRACT PRICE oF woRK_ <br /> [xisting Use af Bwlding - `�EAT SOURCE�. <br /> Proposed Use of Building�_� Gas_ Eiectnc_._ Other_ <br /> Bwlding type: _Single Family i!Duplex_Tov+nhouse _Mul�i-Famlly _Commercial <br /> Type of pro�ect New _Addilion Remodel _Repair_T.I. _Sign_Sprinkler_Demolition_ Change cf Use <br /> DESCRIPTION OF WORK/add�r�ona�space provideo on the backl. <br /> MECHANICAL PERMIT APPLICATION ��UMBING PERMIT APPLICATION <br /> 7ype of Projecl: _New_Addn _AI[eration�Reparr Type of Project: _New_Addn _Alteration ✓Repair <br /> � Show Numbcr N o/lixfures <br /> Show Numbcr(#)a/lixtums . ( 1 <br /> A/C -air handling unils I Toilet <br /> Forced a+r systems 1 Bathiub <br /> Gas pipmg Lavatory (wash bas�n) <br /> Water heater / j Shower <br /> Gas fireplate 9' I Kdchen sink&disposal <br /> Gas range Dishwashcr <br /> Clothes dryer i Clothes v+asher <br /> Range hood I Water heater <br /> Exhaust fan � Smk(servicelbar/moplelc.) <br /> � Hea�p�mp ; 17ack(low preventer <br /> Unit heal=r I Unnal <br /> � 8oiler Drinking Fountain <br /> -� Refngera�ioa � Floor drain <br /> Woodstove I Grease Irap <br /> � Dur,ling � Roof drains _ <br /> Olher � Medical Gas <br /> SPRINKLER ! SUPF�RESSIOPI SYSTEM � Other <br /> � Numberof Heads � Other. <br /> � <br /> 1 hereDy=<nily I�at I have:catl and e�ammed I�i;aFPI�caUen antl tno.v I�e same lo Cc Irue an�corretl All pmms�ons e�lams enC o:tl nances novemng t�is IyGe ol.tme'::i I Le mmp�ictl <br /> ee�i on���,he�spetifetl nereln or not Tne granting of a permd ooes nal presume m gioe aumonty�o vmla'.e er cancei tna provision ol any ot�er s�aie ar iccal i�;�requlaLn3 con:tn:cur,�i <br /> Tl�d!I.lntT..�1�C�4Cd0y��Cawlera�l�is fOpC�ylop¢ROlmIRC\v0lk10fwM1iCbdGP�'����i-ni5ma4CdnJICCm.plyaf,lt!�eSLIcCo'��did:�CrSLa:� 1277fiC:'Ja.ia'.^G200A1":i.0 <br /> li.c,.•_, �- 2/ 2 a <br /> Owner/Au�horized Age ignature Dale (FeaiSeU 3i2013) <br />