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�ERMIT APPLICATI� <br /> BUILDINGIMECHANICALIPLUMBINGISIGN/SPRINKLERfDEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br /> 4 � a� �� <br /> IJOI I-�1�- L"" "^" PROPERN TAX G PERMIT <br /> SITEADDRESS: � � �DD <br /> LEGAL for new conslruclion: Shorl PlaVsubdivision L 'L6t N�.�b (at�ach copy ol long legal Aesc�iplion) <br /> OWNER U JPoe 5� PhonelE-mail � - <br /> A,ltlress �� �•` 1 f��1q 5 �l V2 CilY/Slate/ZiP ���'C, ,� aau a <br /> APPLICANT:_Owner _OwnersAgent _Conlraemr _Coniractor'sAgent T Te����(muslprov�oon�alerotmnsanllrammea.mn�oeawa��mihespace� <br /> �c <br /> CONTRACTOR Slate Lic. # City Bus. Lic. p <br /> Address PhonelEmail ��(JCA IIQl� ���QS�•�1 <br /> C ACT OR IT <br /> �nK.e.n h�pTa�oo �.nc. �1.{I,',� �] 5y5�( <br /> Phone�E�mail l`� r�� <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WURK �� <br /> Existing Use of 8uilding . HEAT SOURCE: <br /> Proposed Use ol Building Gas__ Eiectnc__ Omer_ <br /> Bwlding type: Single Family _Duptex_Townhouse _Mulli�Family _,Commeicial <br /> Type ol project New _Addition __Remodel _ Repair_.TJ._Sign_Sprinkler_Demoll�ion_Change ot Use <br /> DESCRIPTIONOFWORK(aadaiona�spaceprov�yedonrheback): l.+y �� ' , <br /> ��. �n�eoQ sic�h a✓� �� �C(�e e �Ju" °f v`"ue <br /> abo•� doa- w � S��S� sb..�t `b�+ ��� � <br /> MECNANICAL PERMIT APPLICATIO PLUMBING PERMIT APPLICATION <br /> Type ol Projoct: _N N_Addn _Alteration_Repair Type af Project: _New_Addn _Alteration_Repalr <br /> SAow Numbcr(Nl a/(ixfures Show Number(N)ol lixtures <br /> NC-air handGng unils Todet <br /> Forced air systems Bathtub <br /> Gas piping L.vatory(wash basin) <br /> Walei heater Shower <br /> Gas hreplace Kdchen sink 8 disposal <br /> Gas range Dishwasher <br /> Clmhes dryei Clothes washer <br /> Range hooa Waten c�alcr <br /> [xhaust lan Sink(scrvicelbadmoplctc ) <br /> Heat pump Elackflow Urcvcnter(inSiUc blUy) <br /> Umt heater Unnal <br /> F3oilci Dnnkinq 1-ountain <br /> Rclri9erauon f loor drain <br /> Wootlstove _ Greasr.Irap <br /> Ducling Hool dra�n, <br /> Otl�er Mr.dical Gas <br /> SPRINKLER I SUPPRESSION SYSTEM Ot�rer <br /> Numher of Heads Other <br /> I hecebY ceOAY i�a���a°u moJ an0 eram�nrd l�is npp�kation ar.�know I�e saine to be Ime anJ coin:ct All provuluns�'law;unC oiUinances goveming INs type o�wmk will Oe compaed <br /> w�lh whM�G spMd.Cd�Crein r nm T�e 9ianting ol a permii Cou,nol prosume to gne aulhoniv�o violate m u�ncel Uic pwn,io�ol uny olner s1;tle or local law repul.linq consVutl�on <br /> Tna11 i ,Nnm�+ed by Ihc x m ol Ihu prope�V�o crlorm I�e work lor wl�¢h app��cabon�s maAe ana I mmply wiID ihe Slale CaMratlms tu�.v ltl 27 NCW:mJ 79G POOA W�C <br /> O ierl i. oY �A enlSignatur���U�� /� (RevrseUJ/.+Otti) <br /> �l Z <br />