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�ERMIT APPLICATI001 <br />BUILDING/MECHANICAUPLUMBING/SIGNr(SPRINKLER/DEMOLITION <br />CITY OF EVERETT PEFAIT SERVICES <br />3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.Grg <br />SIT AOOR SS: D y� g'i/ r�A� <br />V:I� <br />© O TAX # �O DOG.yt.CJ <br />PERMIT# <br />V <br />i <br />LEGAL lot new construction. Short Plat/subdivision—Lot No. (attach copy of long legal description) <br />OWNER OWNER 7 k 4 Suz &0 /rn_S <br />Phone/E-mail N 'l 2- 99 — `9; Z <br />Address 1/6 IF,Q (/ny f : :. I <br />Giry/StalelLp <br />�g 2 03 <br />APPLICANT: —Owner _Owner's Agent _Contractor Contractor's Agent __Tenant(thus(Pyoweomnerol m�sam aommoowner to ao worvpm me svacal <br />CONTRACTOR A C, i r 0 l?1 , n S }- <br />State tic. # <br />,. ti`bC :'C /L: &y Bus. Uc. <br />en <br />� <br />Addre5s e4 , P(,(� (�(/�i.(.J Y^•Q e)Q M�rf S("I <br />Phone/Email �G'�� p in 66ASV'��@�/m <br />TENANT BUSINESS NAME � � QZ� �o <br />�J <br />CONTACT FOR PERMIT <br />Phone/E-mail <br />BUILDING PERMIT APPLICATION <br />CONTRACTPRICE OFWORK J 000 <br />/]�, <br />Existing Use of Building /�A"62 t sp, trr <br />HEAT SOURCE <br />Proposed Use of Building UGtC"h �'��� Gas _ Electric (, Omer LY <br />Build.ng type: Single Family _ Duplex --Townhouse _ Multi -Family _ Commercial <br />Type ofproject: —Now Addition _ Remodel _ Repair _. _. T.I. _ Sign _Sprinkler Demolition_Chan a of Use <br />DESCRIPTION OF WORK (additional space provided on the hack)' <br />th Gl vs2 Coa v ar 3 arli-o Q..4 Q <br />COS=A�� UtikeA--rr-0 s7O(i- 90t:2M 4v1pEC*- 40046E <br />MECHANICAL PERMIT APPLICATION <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _New _Addn XAlteratlon —Repair <br />Show Number # of fixtures <br />Type of Project: _New _Addn _Alteration _Repair <br />Show Number # of fixtures <br />A/C —air handling units <br />Toilet <br />Forced airs stems <br />_ <br />Bathtub <br />Gas piping <br />Lavatory wash basin <br />Water heater <br />Shower <br />Gas fireplace <br />Kitchen sink & disposal <br />Gas range <br />Dishwasher <br />Clothes dryer <br />Clothes washer <br />Reticle hood <br />Water healer <br />Exhaust fan <br />Sink (service/bar/mop/etc.) <br />Heat pump <br />Backflow preventer <br />Unit heater <br />Urinal <br />Boiler <br />Drinking Fountain <br />RCId eration <br />Floor drain <br />Woodstove <br />Grease trap <br />Ducting <br />Roof drains _ <br />Other 6r_k(r 05i0 _(:,(,/Zj9 c <br />Medical Gas <br />SPRINKLER / SUPPRESSION SYSTEM <br />Other: <br />Number of Heads <br />Other: <br />I hereby earthy that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances govemin9 this type of work will be comps <br />win whether speared herein or nor The granting of a Penn does not presume to give aulhomy to violate or cancel the provision of any other state or local law regulating construction <br />That l a authorized by me o er of this ropetry to perform the work for which apphcalmn is made and l comply with the Stale Contramois Law 1e.27 nCW and 296200A WAC. <br />} /o/21/7-01y <br />/2rVer/Authorized Agcot Signature [)ate (nevisadW014) <br />