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mao�ioo3 <br /> 07/03/�J13 weD 15: ::2 �'tix 425 a87 65?4 NoztcreeY. Roofinq <br /> PERMIT APPLICATION <br /> BUILDINGIMECHANICALIPLUMBINGISIGNISPRINKLERIDEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar SL, Everetl,WA 98201 425-257-6810 FAX 425-257-8857 www.ever�hva�0`r <br /> APPLICATIONS ARE ACCEPTED FROM B AM TO d Ph1 <br /> SITE ADDRESS: . PROPER7VTAl(!1 �E�����.�-1_ _�7 <br /> P � <br /> LEGAL(or new conslruction: Short PlaUsuUdivislon <br /> lot No.__ (altach copy ol long Icgal desuipiion) <br /> OWNER����Q�L�L\ � �� 1 Phonei6mail <br /> AOtlress �j CilylSlate2ip . y � • � <br /> APPLICANT:_O�sner _Owner'sApent�Conim:tar ContractofsAgent _Tenant(m�nc�odaanieseroicvnumrtemc�oc..�e�ioeo�.oa�nme.n�:�l <br /> CONTRACTOR � `� L&I Lic.#CI 5 `I p ' COE Bus.Lic.k G, <br /> \��� s O � p� PhoneiEinail � • ^ L'`a � <br /> nadress ( <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT �� <br /> ����o�c-rlvaree-'roo���n� <br /> Phonel[-inail - <br /> BUILDING PERMIT APPLICATION <br /> CONTRACT PRICE OF WORK u <br /> HEAT SOURCE: <br /> [xisting Use o(Building_ <br /> Gas Electric_ Other_ <br /> Proposed Use of Building � <br /> Buildingtype�SingleFamiiy _Duplex_Townhouse _Mulli-Family _Commercial <br /> T pe of pro'ecl: New Addition� Remodel Re air T.I. Si n Sprinkler Demolition Chan e of Use <br /> DESCRIPTIONOFWORK(adddiona��paceprovidedon�heback): ` `b� �UO�, � d-- �"L � 1"OOT ��j <br /> `lea-r OSs e,ki���� cA�M�OcS �` � ro'�'�- <br /> �o�PoS��1�'�u-�� ��oo�- � ng, D�l� r��lac� �Shee�,��� i � <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> 7ypoofProjacl: _Now_Addn _Allnml�on_Ropatr TypeolProJeet: _Nuw_Addn ,_Altemtion_Ropair <br /> Show Number(q)of fix�wos Show Num6cr/B)o!fixtures <br /> � A!C-airhandlin unils _Toilet <br /> � Forced air systems � �athlub <br /> �� Gas piping Lavatory(wash basin) <br /> Water heater Sho�ver <br /> Gas fueplace : Kitchen sink 8 disposal <br /> Gasrango � �ishwasher <br /> � Clothesd •ar Glolheswasher <br /> Rango hood : Water haater <br /> Exhausltan I Sink(sorvicel6ar/mo Ietc. <br /> � Hea�purop ! BackFlow pt¢ve0�ef <br /> I Urinal <br /> i Unil heat�r � Dnnkin FounWin <br /> I �oiler <br /> Refrigemtion ; Floordrain <br /> � Woodstove � Greaso trap <br /> �ucting RooF drains <br /> ������ � Medicel Gas <br /> SPRINKLER I SUPPRESSION SYSTEM ! Other: <br /> � Number of Heads Other: <br /> I lirreby u!Ary lnal l l�dve renC nnC esam�ncU t�ie opp�����enE Maw Vio somo to Uo Imo nnd ccrtecL AO proviuons ol Uws and oidNanGes govemmq Ilui lype ol woA atl0e mmp�etl <br /> van w�iethe�ipoUfieO hereh or nol.The granln9 of a PemiA aoes nol prowme ro qrvo aW�onry to v�ol�ia or wncel me Dmvisbn of any oNer slelo or kat Ww repNaunq conswction <br /> niai I nm aumorixad Oy i�o owncr ol Nis poDeM�o pehorm No wak Im wl�kh oppi<at�on b mo0o an�I eompy wii�iAe Siete Convanors Lew 18.27 ftC W ond 286.107A WAC. <br /> ��`\All!\11 � ��� "ll✓� � � � �� /Re�dsetl F:'0121 <br /> Owna�lAuthorizedA�enl5i9naturo--T Dale <br />