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� <br />� <br />PERMIT APPLICATION <br />BUILDINGIMECHANICALIPLUMBING/SIGNISPRINKLER/DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />3"00 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 vmrw.everettwa.org <br />-23 —� <br />ADDRESS: PROVCNIY TAX u PERM�T a <br />�ra�i 12n��rv� ��oti�iv P�(3D`6-b0' <br />fa� new conslrucuon� Snon <br />��� <br />Lat No._ (atlacn coPy o� iong legal tlescnplron) <br />S PhonelE�mail —I 2 Jr � Z���� y J�� <br />q �Zo <br />O�sner _Owner'sAgent Contraetor _Contraero�'s�lgenl _Tenanl;m.,:io��,��uam•�ero�u-,��,�no��i,00,ne�iaao»:nmv�z�c�1 <br />�o�n+- .r _ crrn - � n- �u�� i state uc x IZ ENT� ��K�3 f K`1 c��r s�s ��� tt <br />u <br />ING PERMIT APPLICATION <br />7l�] <br />A.lic"� <br />2 5-2 5z - ��15� <br />PRICE OF WORK 4 r00 <br />ng Use ol 6wld�ng I��P ���I VY 0� S� n��'a-vYl ( � <br />�sed Use of Ouilding /;9�A�i� V�SI Gt1' i'1 ��� <br />ng type � Single Family _ Duplex _Townhouse _ Ivtulti•Family _ Commercial <br />o! pro�ec: New �ddiUon � Remodel _ Repar _ T I_ Sian _Spnnkle <br />�RIPTION OF WORK (adoa�enal space p�ov�ded on �ne back� � � <br />�I�uild �xts��S rn(.ld�'DDM 2e lor'a: <br />�,.�, ma(tsh �r�4t���r Wa,C(. �''�'�s <br />MECHANICAL PERMIT APPLICATION <br />ot Pro�ect: _New _Addn _Alteration _Repair <br />Sho�v Numbw (N) o/ /irfures <br />NC — air hanuhnq units <br />Gas <br />Unit <br />� <br />HEAT SOURCE <br />Gas_� Elecinc_ O;r <br />Demold�on Change o <br />_ rn�� r � <br />I�n,l,� <br />PLUMBING PERMIT APPLICATION <br />01 {'rojecl: _New _Addn _Altcrallon _Repair <br />Show Numbcrlp) of fiHures <br />Smk <br />Root drains <br />Pdedical Ga <br />Olher <br />Other: <br />r. <br />I he�eEy cen'y that I �ove reaC antl ewm�nea I�is appPwtian an0 know t�e same lo Oe Iroe antl curcct All piovisions ol laws a�a artllnances govem�ng 1��5 type ol worF �ril �e tompl�ea <br />wn].��einer spenfieC �crnn or nol T�e oWnting o� d O��mO Coes not presume to gne authCnly lo r.olate o� canccl I�e p:ov�sion ol any oIDer state or loCal law regWahng consWttion <br />Tnai i am a�.,monm0 Oy I�e nvne� ol mis prepertY �o perlorm tne work br wnrc� appi�cat�on rs maGe anC I comDb �+'�� t�e Slaie Contracion lmv 7B t7 PC�V m0 255 200A WAC. � <br />��� � v <br />�v ncr ut ori d Agent &gnaturc Date (Rev�sed 3/1073) <br />