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� � • <br /> PERMIT APPLiCATION <br /> BUILDING/MECHANICALIPLUMBINGISiGN/SPRINKLER/DEMOLITION <br /> CITI' OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www everettwa.org <br /> qS0 <br /> SITE ADURESS: PRONENTY TAX p PERh11T k <br /> C� '32c1 /�J�z. 5�.^ �ri_LT -�� <br /> LEGAL lor nc�v mnstiuclion: Snort PiaUsu601vision�L�.N2��Q- Q�'� l01 No. � (aBach copp ol lor.g legal tic;cf�plian) <br /> OWNER�a,Lr� Pau�•�- �i'�`M�Z-5 PhonelE�mail 4Z.5� �-'(�j�'Z��V <br /> izo s.,., �.v�o°�Z' vyv.�` �...v-t c�ivisia�erz�o �J61�--Pa-C l,lA • �'t�2a� <br /> aCaress $�7 i'�'4_ pp <br /> APPUCANT: Oeme� Ovmei5A9Cnl CGntraclor COnlra[tor'SA9Cni _Tenanilm�eiprc.•aoaie*.ercimnsrrnmm•,noeanernnwoMn�,n�sp,:��1 <br /> CONTRACTO(��ATI� A-�-�FiC- k��nnc'�S s�a��u�. �en ooS f3J cay e�s ��� u(p03- Z� -3(� <br /> ndaress �4V"l�• <br /> Fnone�em,-�� $A�nc�. - <br /> TENANT BUSINE55 NAME CONTACT FOR PERMIT ��y� �y�W�,Zd <br /> anone�E�ma���4Z5� 3`�'D"��o2 , <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Exisling Use o(Buddin9 HEAT SOURCE�. <br /> Proposed Use o(Bwlding Gas I�Eiectric_ Glher_ <br /> �wlding rype� ,�Single Family _Duplea_Townhouse _h^ulti�Pamdy _Commercial <br /> TyDe o1 projecF. _�/Ne�v Addition _Remodel _Repair_T I._Sign_Sprinkler_Demohhon_Change ol Use <br /> DESCRIPTIONOFWORK(aed�i�onaispacep�o+:aeaa�;neback) .Z � �, �` ������ <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLIGATION <br /> Type ol Proj:ct _New_Addn _Alteralion_Repair Type ol ProJecC _New_Atldn _Alleralion_Repair <br /> Sltow Nurtrbcr(C)o/lulures Show NumUcr(0)al6xfurrs <br /> NC-air handling units TodM <br /> ( Forced air sys'ems 2. I Dathtub <br /> � Gas piping � Lavatory(wash basin) <br /> � � Water heater 2, � Showei <br /> Gas fireplaw � Kitchen sink 8 disposal <br /> � � Gas range Dishwasher <br /> � Clothes drycr ( ; Clolhes washer <br /> � Range haad ' ' <br /> [xhaust fan Smk(servicelbadmopletc) <br /> Heat pump 6ackilow preventer <br /> — Unil hcafer Urmal <br /> Doiler � I Dnnkmg Founlain <br /> Refn9erahon � � Floor drain <br /> Woodstove •� Grease Irap <br /> DucGng � Rooldrams Wiv is - <br /> Othcr Nletlical Gas <br /> SPRINKLER I SUPPRESSION SYSTEM O�her. <br /> � Number of Heatls � Olher� <br /> I!•.ereJYcertAyth;nlpmeiea in4e�am.neCl�isappl.r�lionan7Anowl�esameloCelmeandm!rect >��pmvs�.onsc'I�,�sandorCinancesyovermngt��slypeolwodw<ICecnmp�ru <br /> wAh��he:nerspe�hi ne�el o no Tneg�anhn9olapennAeoesnotpresumeWqueautnonlyfooio'alecrcancellneFrcvisionolanyolnerslaleorloealtawre3ulatingcenstmc:ic� <br /> That I am nN�er �y t�e e c i�is D�cOe�y lo pciiorm I�c wor�ior�M¢�aopi��cation rs maae ana I comply�vu�i�e Slale CanlraCo�s LaN 18 P FCN anC 2?fi 200A N'AC <br /> , 5 • 13- I � `�z <br /> OwnerlA urizedAgentSignalure Da�e p7eviscU7/7J73) <br />