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�ERMIT APPLICATIO� <br /> BUILDING/MECHANICALIPLUMBINGISIGN/SPRINKLERIDEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br /> SITE AODRESS: 1?•t� PNOPERTY TAIf M P �T R _ <br /> 20 4> �ST 2Ik�•1�D �. �vc <br /> LEOAL for new wnslnxtion: Short PlaVsuCEivision Lol No._ (anach copy ot long legal Aescnplion) <br /> OWNER ON � C' PnonelE-mail �16 '��'2��3 <br /> AECress �j�� D�uEs �E� �'� CitylSlatelZip �oul�u-, f�l �{q 331 <br /> APPLICANT: Owner nersAgent Comractor ConlractofsAgent _Tenanllm�v��s.nneracrosemirommso.n.noao.onMuww�l <br /> CONTRACTOR � � LQN��L� State�ic.N 3LC�iEMIi�{8159 Cit Bus. Lic.q <br /> neeress �31b "13�Ft`' Sj 5E, M�u. C2�e�; w4 q8012 PhoneiEmai� ZS'-'��q-q565 � uorenCG� <br /> N U I SS N CONTACT FOR PERMIT JO��� <br /> E ���'L 1�-1 G►�`� <br /> Phane/E-mail Zfl6-660- 0 a � �a � �'� <br /> BUILDING PERMIT APPLICATION CON'fRACT PRICE OF WORK `�I I Oo� <br /> Ezisting Use o(Building S�.Dicf.1G� HEAT SOURCE <br /> Proposed Use of Building�YcSt O�F4.f�`� Gas Electnc Other <br /> Building type: x Single Family _Duplex_Townhause _Multi-Family _Comi��ercia� <br /> T of pro'ect: New Addition Remodel �C Re air T.I. Sign Sprinkler_Demolition_Change of Use <br /> DESCRIPTION OF WORK;edaaronei space pro�rdea o�me eack�: r��1 Mµ� '���l ��� <br /> �_,� <br /> pe��ati R�Mov,u. o� Ex�s�� M�;�.�j _ i <br /> E��Si�Na CzooF � �-aoJc. c��n+�NcTs• (hy�PryoX. 3�5F) <br /> MECMANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> �yq o�pro��cL _New_AdAn _Alteratlon,_Rapair Typa o�Prol�et: _New_Addn _Alleratlon_Rspalr <br /> Show NumAer(�J o//lufures SAow Number(N)o//trfuns <br /> AIC—airhandlin units I Toilel <br /> Forced air s stems _ qa+htub <br /> Gas pi ing Lavalo wash basin) <br /> Water heater Shower <br /> Gas fire lace Kitchen sink L dis sal <br /> Gas ran e Dishwasher <br /> Clothes A er Clothes washer <br /> Ran e hood Water heater <br /> Exhausl lan Sink(servicelbarlmoplelc.) <br /> Heal um Backtlow revenler <br /> Unil heater Urinal <br /> Boiler Drinkin Founlain <br /> Refri era�ion Floor drain <br /> Woodslove Grease tra <br /> Ductin Roof drains <br /> Other Medical Gas <br /> SPRINKLER I SUPPRESSION SYSTEM Other: <br /> Number of Heads Other: <br /> I�ereby ce�M�hN I Asre reM erM azamine0lhie apptiratbn anE know Ihe seme lo De Irua enE cartect.AA pmWsbns d laws en0 oMmances qovemirg t�la Iype olwark x111 De complKtl <br /> ��wt�eMx specfiM Aerein or irol.Th�grenling o�e permA Eoes nol pewme lo qive autMrMy lo violate ar cancel tne provision ol any otOtt slaie a bwl law regulnMq con�trunbn <br /> 1M1 I em aN�oraed by Ne owner oi I�if propeRy la pedorm I�e woA lo�x1iiM application Is maEe en01 camply wlt�l�e Slale ContrMors law 18.27 RCW anE t%.t00A WAC. <br /> �L <br /> b b/ol//3 <br /> n�r�Aut Fied Agenl SignNum �� (Revised 3/1013) <br />