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:-.. 22. 2 '12 2 , �6�"; �V�;G;E�N SIAIE HEAI +� AC '��• ' ';� ' � � <br /> PERMIT APPLICATION <br /> BUILDINGIMECHANICALIPLUMBING/SIGNISPRINKLERIDEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everelt,V��A 98201 -42� 257-8810—FAX 425-257-BB57—ewwv.everetlwa.org <br /> APFLIGA'fIONS ARE ACCEPTED FROM B AM TO S PM <br /> SITE D� ESS: PROPERTYTIUfM PERM��_� _� <br /> u`�3 ��-e.,-Lr� �-V P - <br /> LEGAL for new mnslrutlbnt Short F�aUsubdldslon_ Lol Nc._ (ellad�wyy ol bo8 ie9nl descdptbn) <br /> OL9NER V V- �.+ Y�5�. �w�o�E�ma�l �.a5 - a-31' - 1 �� I <br /> MOR?9� 1 �� `7��'�7 ���Q aryrstai�z�v d21LQ.,� �,� ov <br /> CONTRACTOR � � L d I L1c.# P �S O o1��b� <br /> /Wdrees •' ().C„��5�, �F'3�/Qh�� �� PhauiLmaO �'[' r�` d�,� `�I� <br /> TEIJA�IT BUBINE$$NAME CONTACT FOR PER_ MIT _ <br /> �„('� �(l_1'�5� PhonelE�mall ��.•�' <br /> � <br /> BUILDING PERMIT APPLICATION coN7RACT PRICH oF WORK <br /> ExIsllnc�UsoofBu➢dlnq �s�CI-��I�- NEATSOURCE' <br /> Proposed Use of Bullding ��� Gas eixtrt rnno�__ <br /> Buildinglype: �SingloFamily �,Duplax,Townhousa _Mull'�Faniily �CoinmerGal <br /> Typoolpro�ocl: _New _Addlllon _Romalol _Repalr�T.l.__Sipn_Sprinkler_Demolltlon_Change otUse <br /> Descriplion ot Work(sddlllon�l spaco provkled on Iho Dxk): (� � � � � <br /> '���9.Ca Cjoa +�11✓v'��R c.,� / D�.Gl S -� w�r'�`c2 <br /> HavoyouataAedworkln�wllhoutapemdt7 _YES �NO � U <br /> MECHANICAI. PERMIT APPI.ICATION PLUM8ING PERMIT APPLICATION <br /> TypeolP�o�etl: _Nnw_Addn Alloratlon_Rapalr rypeofProject: _New_Addn _Allerelion_Repair <br /> SbuwNumber tl o1/ixlvree ShowN��m6ur(fqo/Ortums <br /> IVC—air handling unils Toilet <br /> Porced elr s etems Belhlub <br /> Gas i in Lavato wash b251n <br /> Weter heater Shower <br /> Gas Gro lace Kitchen stnk&dlsposnl <br /> Gas range Dishw�sher <br /> CIo11wsU or Clolhesws,her <br /> Range hood �'1a10r heater <br /> EHhnusl tan Slnk(aervltePoedmoplelc.) <br /> Heal um Backllow revenler <br /> Unll heater Urinal <br /> Boiler Drinkl Founta6i <br /> Refd emllon Floordrain <br /> Woodstove Gf9dse Ira <br /> Duttln Rool drains <br /> Olher Medical Gas <br /> SpRINKLER/SUPPRESSION SY3TEM olher. <br /> Nuinber ot Heads Ofher: <br /> I herahi caNty Uial I have read aM ozamined Ihls applkauon arw!W�o�v Ihe same to I�a liva end car�ec4 n11 puvi5bns of lews end wdinenoee gove�nrg <br /> Uils lype of�wrk WII be cpnplied N1N wfielher speGfied liere4?oriwl.Tht grdnUrp o(a perm�l does nol presume to p(ve suUunty b violafe er cencel <br /> u;c�rovision of any other al�+le or bcsl law repWaGnq conslniction or Ne pertwmance of consuucUm.That I am au�wrked by tho a.�nor d Uils propeiry <br /> lo parform u�e�wrk(ocNiveh eppl�eotia,is medo and I eompy w(Ih lhe Slate Conir�tors Lerv+18.27 ftCW and 296200 WAC <br /> � �.�„��� �- aa--ia <br /> OwneriAulhor�:ed Agenl Signalure Pnle (Revlsed?1201!) <br />