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� � <br /> PERMIT AP�'LICATION <br /> BUILDING/MECHANICALIPLUMBINGISIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett. V�JA 98201 425-257-8810 FAX 425-257-8857 w�rnv.everelt�va ory <br /> 5 - � 3-� Y <br /> SITE ADDRESS: PHOarHTV TaN PE :�IT a <br /> _ 4/�O / iQic���jr�r � v o�V6Y�a0007Yo0 �J- <br /> LEGAL lor ne:�consirucron� Short F�aUsubaivr�on Lot Ko_ (attach copy ol long Iegal Cescnolron) <br /> 7 d <br /> ' S ;, 8 - `r - 9' 7 O <br /> UWNER p �' o Pna�e�[�mad <br /> :dd�essa d / � WC�C � CrtYStaic2��p SN ON e{Q�! / � <br /> APPUCANT. _Crirer G.vner'sr�gcnt Conl�,cicr _�ConbacioisAgenl _Tr.nant��„•.��nv..cu.,�,��.�„ «..�.,�..,��.�oon�^��._�+��:.�,�•o*:+=•� <br /> CON7RACTOR U/�1 d2� State lic � Gty Bcs. Lic +7 <br /> Pnane�[mad <br /> �tCU�ess <br /> TENANT BUSINESS NAME CONTACT FOR PERf.11T �. K�� t^ , S �_ <br /> PF.onerE�n,ai� �� v _47�_ " � �D <br /> BUILDING PERMIT APPLICATION CONTRACTPRICE OF WORK .ZiGb� <br /> ,[���� H6\T SOURCE <br /> Ex�sUng Use of Bu�lding �P� • 7��" <br /> Proposed Use of Byulaing �e S . _ S� Gas�Eiectr�c _ Oiher_ <br /> Bw'ding type �Sir9ie Famdy _Duplee_To�.tnhcuse _tvlulli�Famdy _Ccmmerual <br /> Typ� of p�o�ect Nev+ Atld�Uon _ _ Re�cdel _ Re�mr___T I __. S��n _Spnnkler___Demo'd�on_Chan,e ol Use <br /> DESCRIPTION OF WORK �ada'o;,��.;ac_.-rc:Cedm,u:e:ae:! � � w o� e C rC <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> 7ype ol Pwject: _Nav_Addn ___A��cralion_Repair Typc ol PmjccC _New_Atltln _Altcration_Repair <br /> Show 7lumbcr(u)ol lirNres Show Nwnbrr�a)a/ll+fuics <br /> A/C—av nandhng unds I To�let <br /> � forced art systems ! E3alhtub <br /> � Gas pipmg Lavatory(v:ash basin) <br /> Water healer � Sho�.ver <br /> Gas hreplace I Kikhen sink 8 disposal <br /> � Gas rangc U��shwashc� <br /> I Clothes drycr Clothes�vasher <br /> ! Range hood i Water heater <br /> � � Evhaust fan _ I S�.nk (service/banmopletc) <br /> � Heatpump I �ackf!owprevenler <br /> � Und heaier I Ur.nal <br /> � 13aler ! Dnnkmc �ounla�n <br /> � Refngerat�on i f'loor dra n <br /> � Woodslove I Grease Irap _ <br /> �U����9 I Roof diains <br /> I _ _ i Medical Gas <br /> Other <br /> SPRINKLER / Sl1PPRESSION SYSTEM i Otner <br /> Number ol Heads � Other. <br /> I ne:eGi«�'�y������ave read ina e.ammea In�s apF�wucn a�d V now I�e samo to Ce Irve antl cmrecl 41I pmv3�on:ol laxs anC ortlinances govem�ng tn'.,Iqp^ol�vorA v:i I hU comp'en <br /> w��� mether spea�c�ncrem ci nM ine gran��n3 c�a eerml Cocs not pwsume to 9rve avtnonty�o noiate ar wnce���e e�o�isicn ol anY c��ci s�a�c ot�acal�aw ic�Wa�n,censv�amn <br /> inml�ma�mtnxceey!neoem IlNsproFenympe�crmineNo�klorxMchapp'.cai�cn�smaCear0lm^�C�Y����nReS!a�eConVaziorslawlB2iRLWtne2967004t1'AC `(� <br /> � <br /> �_�+f <br /> OwnerlAu ized gentSignaturc Date (Reei5ed.12013) <br />