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a�a <br /> � � <br /> PERMIT APPI_ICATION <br /> BUILDINGlMECHANICALIPLUMBING/SIGNISPRINKLER/DENIOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar SL, Everett, WA 98201 425-257•8810 FAX 425-257•8857 �+nvw everelhva org <br /> SIT A�DRESS: / .�� i In (J4�/ PROPERTY TN(p PE II� 'O <br /> / T � <br /> LEGAL for new construc��on Shoa t'IaVsuCm�isian » lol No_ (altach copy ol long legal descnphon) <br /> OWNEI7�� £7y' QGS/,N �!�� Phonc/E�m I �S Q�f� �Of p <br /> aaaress ' � � �L 'rje{{� c�ty�5later2�p fji"- L /�. <br /> APPLICANT: Owner OwneYtA9eni Conlydtior Conitadoi5A9enl Ten,lnl�musipm.�eealeeacrmvaiuo�m�w�+�uoo..w��nU^spacel <br /> CONTRACTOR L 7�l}R. ONJ��UC�i� StateLic x QC��v 7� /C(� GlyBus l�c.# <br /> D 0 �/��I <br /> nad�ess P,O 0 O �j PnanNEma�l �pC Q2/G ST✓C lOJ Cak' <br /> TE/NANT BUSINE S NAh7E CONTACT FOR PERMIT <br /> '//� �—�/1]�/J�/�/����fI �Q��'� i e <br /> {/�y�( / • / �v�L/�`_ Ft10r.CIL�mJ�1 � � � �(./ <br /> BUILDING PERMIT` PLICATION CONTRACT PRICE OF WO <br /> [Risl:rg Use of Bud�ing H T SOURCE <br /> Proposed Use of 6u�idmg Gas _ eiec�nc___ omer_ <br /> �udd�ng type. _S�ogle Famdy _Duplex_To�..nhouse _�+lulti-Famdy _Commerual <br /> 7ype of Droiect New �ldtldwn Remodel _Reoa�r T I _S�qn_Spnnkle Demotit�un Change o1 Use <br /> �SCRIPTION OF WORK laco/�n�oral s�ace praneed on Q�r,�oac.1� �1 <br /> �i�10 dti �.j(i5�'in,q f-u2n)aC rC.� /� f� �nC ti �/Q� 4 �4��1 FcQ �/1�fc,t� /'U/�+�Jac F / <br /> d <br /> MECHANICAL PER IT APPLICATION PLUMBING PERMIT APPIICATION <br /> Type ol PmjecC _New_ACdn AltcoUon_Repalr Typo ol Projecf. _New_/lddn _Alicralion_Rcpair <br /> Show NumDcr(►' o1li+fures Show NumDcr(X)ollirfures <br /> � AIC-air handhng umts I Talel <br /> I Forced air syslzms I Bathtub <br /> I Gas p�pmg I Lavatory�wash ba:m) <br /> Water hea;er � Shower <br /> Gas fi�ep:ace � K�ichen sink 8 disposal <br /> I Gas nnqe Oishwashcr <br /> 1 CIOth�5 dryer I ClOtnes washer <br /> Rangc hood ; Water he.iter <br /> Exhausi'�n � I S�nk (serv.ceivadmoD�etc � <br /> � Heat pump I BdCkflow provenler <br /> I Und heaier ��/L�JAC � I Ur�nai <br /> I Boiler I Dnnking Founta�n <br /> I Reingerabon I Flom d�-n <br /> I Wooasrove I Gf[d'.^I Jy <br /> � Duchng I Rool�trams <br /> � Olher � fdedica:Gas <br /> SPRINKLER I SUPPRESSION SYSTEM � Otner <br /> ( Number o(Heads I O�her. <br /> �neeeC�cehdy mai i n�ve rea0 anU e•am•neC m�;a�p'�catron an�hnow Ine same�o�e true anC canect L��prors�rns ol�aws a�d o�tl nances qavem�ng i��s I�Ce al wan w9i�e comp'ed <br /> wnn wnemer spec�� nercm or not ine 9'aneng ot emm tloes nm presume 10 yne awnor ly la v'aate or cance�me C'ovu:on of an�avrr s�a4 oi ixa��nw reguiai�ng co�snv�on <br /> Tn�l l dn auln .ca Cy 1ne awnn oI1m5 prDpe qorm Ine nOrl Icr wr�N applsdlion iS mdCc anC I tampl��.�n ine 5ia�e Ccn'�actas�a.v 19 77 RC:;anQ;y5 2C0A Y:AC <br /> i ` � � <br /> . � o,y <br /> /OwnedAuthorizcA Agent gnaturo �a (Rewsed 3/10t3) <br />