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a�a <br /> � � <br /> PERMIT APPLICATION <br /> BUILDING/MECHANICALIPLUMBING/SIGN/SPRINKLERIDEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Fverett, WA 98201 425-257•8810 FAX 425-257-8657 ww�,v everettwa org <br /> SI�ADDRES�Y ' _ ^�^^/ PROPFRiYiAXp � P MII ��'� D D <br /> T. '7 o�i <br /> LEGAL lor new construction Shcn PlaVsu�d�v�sion Lol No_ (allach capy ol long Iegai desuiption) <br /> OWNER� ��' QUS/!1 � t�1�1 I�� PnonaE�m i �S Q�����8 <br /> ndaress ' � � �L Tjt{� GtyiSiate2�p f Jf— //�... <br /> APPUCANT: Owner Owner'SAgen1 Contractor _CoNractoisP9en1 TeWf1I�TUSIptp�JCd10]frO:CO�SP'115GT?OOwOl1'OOp+Clf�9N95LdCn) <br /> CONTRACTOR L 7�R1�. ON�ieUC�i A�1 State Lic. tt QCKS` 9O RCi City�us Lic # <br /> /� 0 b/i1� <br /> aCOressP. O 0 0 , �j PhonclEmau �Q� d�C./� ST IIL lOJ •C6'I✓ <br /> TENANT BUSINE S NAME CONTACT FOR PERMIT <br /> � r <br /> �'e��.f� 0�� �- ' <br /> y rJ� �^ Phonc�E�maJ � � Gn /�I�� <br /> BUILDING PERMIT` PLICATION CONTRACT PRICE OF WO 2 <br /> Existing Use cf BuJding HF T SOURCE <br /> Proposed Use ol Builtling Gas Electnc Olner_ <br /> Bmid�ng lyoe _Single Fam�ly _Duplez_Townhouse _Pdulti�Pam�ly _Commerciai <br /> Tyoe of oro�ed New Add�bon Remodel Repa�r_TJ _Sign_Spnnkie �emolJ�on Change ol Use <br /> �SCRIPTIONOFWORK(aCoucne�spa:epro�:�edonrnooack) � �i <br /> �,�o�ti �,s�,N� �a�ac�.� Rfpl��cti �/0� 4 so�p��f�Q. �i�� ��,�� F <br /> MECHANICAL PER IT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Pro�ect: _New_Addn Allcration_Repair Typc ol Project: _New_Adtln _Alteralian_Repair <br /> Show Numbcr(p ol/ixfures Show Numbcr(tl)ol firNrcS <br /> � NC—air handling umis � Toilel <br /> � I-orced air systems � Bathtub <br /> i Gas p�ping � Lavalory(wash basm) <br /> � Water healer � Shower <br /> Gas fireplace � Kilchen sink&d�sposal <br /> I Gas range Dishwasher <br /> i CloRies dryer I Clothes washer <br /> ; RanUe hood i Watcn c�aler <br /> [Mhaust fan I Sink(service�6admopletc) <br /> � Heal pump I Bachllow prevenler <br /> I Unit heater p Q�/qC � Urinai <br /> � Boiler ! Orink�ng Fountam <br /> � Reing?ration j FlOordrain <br /> Woodstove � Grease trap - <br /> DucUng I Rool drams <br /> � Other � Ivledical Gas <br /> SPRINKLER I SUPPRESSION SYSTEM j OUer <br /> � Number of Heads I Other: <br /> I OemCy cemty In�i I hove reaaana e.am�ned ms appllcanon and lnow I�e same lo Ee Ime anC conen All p�ovmons ol iaws anC we.nanus govemmg ms IrPe ol wom m�Oe compee0 <br /> w�:n w�ei�er SpeM� neiem cr noi Tne grani�ng at erml aoei nat presume to give aull+or.iy Io violaie or cmcel IP.e Fmnsi:n ol anY cl�e�siaie c�iowi lu.r requiai�ng�cutruct��n <br /> Tnat I om auln ea�y me onner ol mis pmpert �ortn me xmk lor wn�appbulmn rs maee an�I cempiy w,m me Slaic Cc�Vaaeis lae 19 21 9C�Yaw 25e iCOn�YnC <br /> � <br /> " � r � S o/y <br /> OwnerlAuthorizedAgent gnaWrc Da �Rcv�sedl?01J1 <br />