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( <br /> PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGNISPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> '_Z00 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettvU+a.org <br /> APPL�CATIONSAREACCEPTEDFROMBAMT04PM 1��� ��� <br /> SITEA�DftESS: PftOPER1Y7A%N R � . 'O'�S <br /> � [/J' �Gz/c 'h "iT � � ':s`��7 <br /> LEGAL Ci rew ccnsiruct�o� Snoit PlaVsu���vrslon Lot No._ laltacn eepy of long legal aesuipDen) � <br /> .�Q�K ���y.�.';i2rJ <br /> OWNER /-,.�':_"�.:��:i /1�.J5/i7�G /?c ;Nc;E�<i� Pno�e�E-ma�l 4�'> <br /> ;�.�e:: .:/U u�jU�/:9dc.' i.:��it'r_'�i uJ�. 9d'�' C�tyBtate2ip tili"idv/T u//J �i'YZ�i <br /> APPUCANT:_Onner OwnersAgenl Contraclor _Co�«actor'eAgent _Tenanttmmicm�m.�rwro�wm•mn�,n•owurwaownm��•+ca:.� <br /> CONTRACTOR ,:�n�:L:" �c'nZ�G�1,�iiJ[�,$ . <i✓G L&I Lic.# �-�� XS/L,�/ L' COH Bus.Lic.# �+I v <br /> . .� + � �• � i � PheneiEmail �' -"-�J ' � �%/(O <br /> 4�:icss .�Si.�G' .�i/�iif"�ft-C: C�i1L'/rL41� dl�/ <br /> TENANT BUSINESS NAM17E CONTACT FOR PERMIT T�,�„-2:✓�G <br /> - �C ir J?tJi - /lt'�'iY/U%i l <br /> P�onelE�mall y15- Q�/�4,�'�f/ <br /> BUILDING PERMIT APPLICATION CONTRACTPRICEOFWORK -�4C1/) (�� f�'��r - <br /> c.sCng Use ol Bwltling � / <br /> Gl,u�7 /)Lcl'//,�-� HEATSOURCE�. <br /> 1KC�r� rili»L% Gas !� Eiectnc Otne� <br /> urposetl Use of BadGing / Y / <br /> ii�,raing tyFe S�ngle Fam�ly _,Duplec_Townhouse !%MNti•Family _Commerclal <br /> 1 yce of P�ojeci� Nex AdOAion Remotlel Repair T.I. Si n Sprinkler Demolition Chan e o`Use <br /> DESCRIPTIONOFWORK�ade�ncnalspacec�ovitletlonl�e0a[�)��ty�clLGz �?���ri.tir_�, r+:.u��(� 7��S /Xl<�7:/��-�-; <br /> I .. �� ' .... �' ' '✓,�✓ ,il.�'J,U¢'G� , ,1;.4�G/[��r11L t7l- JI1C l-c7i�C�0�.::c� •/f-/��51Ji7h'iuti%, <br /> : rr, � . ;i'_'.i .l"._ c;� i (1 <br /> �� , ,7j �:Z�;� `-, ,j ,U��),:�v U:v/L tYLC�Lt/ J011"ijG�'r C✓ItirJ/_� .�i7Nl� <br /> ,�ir,�� �'ic:��c:s'l� � <br /> ' J MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> ;y;.�.o�project�. _,New_AUUn ,_�Iteratlon_Repalr TypoolPro�aet _New_AEdn _Alteralian_Repair <br /> Show NumOer(Ml of tiitures <br /> Sl�o��Nwnbw(a1 0l li+Wret � TOdet <br /> �. � NC—air nantlling uni�s BalhN6 <br /> ' .. „ . I Forcetl au systems <br /> Levato pvash basin) <br /> � � Gas pioina � Shower <br /> ' � t:'ater neater Kitchen sink 8 disposal <br /> � GBS Iue01aC0 Dis�washer <br /> ' ' Gas ranae Clo��es was�er <br /> �- � Cioihes ap�er Water heater <br /> � Range hoetl Smk(service�barlmcp'etc) <br /> ' ' E�naust lan � <br /> ' Heat Fumo Back(low preventer <br /> Un�t heater <br /> Urinal <br /> � Doder I <br /> �rinkin Fountaln <br /> Floor tlrem <br /> ' Refr�erat:en Grease trap <br /> '- l:'000s;o.e � Rooldtains <br /> ' Dxt�nq hletlical Gas <br /> .. .— Olt��er <br /> SPRINKLER / SUPPRESSION SYSTEM Other: <br /> Number of Heads Other. <br /> � � .: .� r .,�ii�.�li.u,.�;�"�e.on�e�rt�suppl.calicnendAnowlnafeme.Jt�uvuuanCWrtec1.l.IpmvsmfollaaiJnJaa.nane]QFem:����lp�ud.'•�• �,..'. <br /> .. v'����. 'r �p �� .. e'�,.� ��dpeim.JJCHnclprolumBlu9�eouCtcn^�IO�e'Jnifc��.eltF�.eLrUs..nclu�� sal pr��. a�� � �dL^: . <br /> _; p-;�,. .r,:ldby���`�O..ne1011'9rC:!'71J^vcrtCtTlhOnOl4101wlIKbBpphCBlroOfTdde¢P^.ICC�nF`Jn��.�tlS'a'oC.. �aC..t5Lav10:iRC1.J�di•u:P'A'•1^� <br /> �� _`� � D�G�-Zo/3 <br /> , <br /> � � i v:e„sec r... .-. <br /> ;:.r.e�.FuR�ori:ta A9enI5i9��ature Dale <br />