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� �ERMIT APPLICATI� <br />BUILDING/MECHANICAUPLUMBINGISIGNISPRINKLERIDEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everetiwa.org <br />`7 —��—/ � <br />)DRE55: ' ' '""� �� <br />, y N�-SSU� �� IA - <br />for new conslruelion: Shotl PlaUsuhdivislon Loi No._ (atlach copy of IOng le9al description) <br />�j/LL L!/L✓1'S <br />�VO z N�- SSL(q- �L � �Cily/5tatelLp <br />4NT:,_Owner _Owner'sA9ent �CoNrac�or �ConlracbYsAgenl _.Tenantim�.ipro�maoten�ro+con:omaommcow�reriaaowonmme:p,e� <br />4CTOR!"��oN l 7/�G �G S1a�eLic.# �G ��LSo/fLS53��GCityBus.Lic.#�j9 <br />jcr27��y Ove�'cit �q✓� PhonelEmall 4 LS ' 2-S�' � 3o u <br />GONTACT FOR PERM�T J�� <br />57�.: a.-7 N ' <br />PhonclE-mail GZ�' -7 � 3 - � 7 � � � <br />)ING PERMIT APPLICATION CONTRnc7 PRICE oF woRK <br />HEAT SOURCE: <br />Use of Building <br />�sed Use ot Building — -- <br />ng type: Single Family _ Duplex _Townhouse _ Multi-Pamily _ Commercial <br />of project New _ Aadition _ Remodel _ Repair _ T.i. _ Sign __Sprinkler _Demolition_Change of Use <br />CRIPTIONOFWORK(add;fionalspaceprovidedonlheback�: OV���o� �N�7 <br />i2��c,c�-t� �Y�S�'�� /-1-/G <br />MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATIO <br />ot Projcct: _New _�ddn _Alleratlon _Repair Type ol Pmjwt: _New _Addn _,Allention _Repair <br />Show Nomber (p) a! lirtures Sbmv Numbcr (N) o! f�xtures <br />NC - air handling units Toile! _ <br />Forced au systen:s Halhtub ` ` <br />-- � --. ...-- -:.,� <br />Medica� Gas <br />ION SYS7�M � � � othec <br />I 1 Number o( fieads I I � � <br />I hereUy ce�Lly Ihat 1 h�ve re. J �nd examined Ihl, appllwllon and know Ihe same to be Irue antl rortecL All piovi:ions ol laws and mdinan<es 9overninq ihis lype o� wmh wi I pe mmphed <br />wi;� whclhct ,pceiGcd hcrcln of nol 7 �nlin9 0l o pc�mA doca nol prc;umc l0 9na aulhonly lo viulalc or eanecl Nc pmvuion ol any olhef :��b: o� lor.al law rc9ulatin9 eonshuclion <br />7ha1 I:�m �Nhonred 0�� vncr ol l�i� pwperry to petlnrtn ihc woik lo� wAicli app6calion is m�tic and 1 compty vr.lh ihc :�ala CoN�aclor t nw 70.77 RCW and 296.YOOA WAC. <br />����� --- -- --�--'— Uale ((iCvisld4/2015) <br />Owned�Who�i¢ed Agent Sigwlure ` <br />`�i <br />