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� � <br />PERMIT APPLICATION <br />BUILDINGIMECHANICALIPLUMBING/SIGN/SPRINKLER/DEMOLITION <br />CITY QF EVERETT PERMIT SERVICES <br />3200 Ce �r St., Eve�j 201 425-257-8810 FAX 425-257-8857 v�rn�w.everettwa.org <br />�z--Q+� Av�.s�. �al�� I I /'.INO�f -bf,(� <br />lor new conslruction: ShoM1 PlaVsubCiviSionC���� \�•� ' Lol No.1_ (altach copy ol long legal tlesciiption) <br />;5��(.�Z P�}C_,( (�\C., �-�(�,N�,FL$ PhonelE�mail QZ.S� ��j3���i0� <br />j Z,Q 5�,•, QV4/Z,'�,LT ►V1�41.1., �p..� City/State2ip �j� IAJ� . Cj U2t%� <br />ANT: Owner Owner'sAgent Coniraclor ConLaUOYsA9ent Tenanl�m�sicm.�coaian�r�icoosemnw�moo+��wnoaowannmasoaul <br />ACT[1R 5coz-r�� PAc��� �i6AG� StateLic.#_� NON�pOS'�V CIIyBUS.LIC.M(`�.���(e <br />S l� v��� <br />Phone�Email S�U�� <br />._.....- --- �D��.`_ Ut-Au,�o�-d '--�-�. <br />Phone/E�ma�l C�L$� �j�j ^���Z- <br />BUILa1NG PERMIT APPLICAI'ION CONTRACT PRICE OF WORK <br />Existing Use of Builtling HEAT SOURCE' <br />Proposed Use of Building _ Gas ✓ Eleclnc_ i <br />Building type: �Sinyle Famlly _ �uplez _Townhouse _ Multi-fai�,�ly _ Commercial <br />Type of prolecl: ✓New __ Addltion Remodel Repair _, T.I. _ Sign _Sprinkier _Demoli�ion_Changf <br />DESCRIPTION OF WORK(add�fiona�spacepiv�idedon�he�ack): <br />lto90 �w.-� Z c-� �,��� <br />MECHANICAL PERMIT APPLICATtON <br />ypc of ProJocl: V New__Addn _Aitetatlon _Ropalr <br />— I Number <br />Use <br />PLUMBING PERMIT APPLICATION <br />oiProfect: ✓New__Addn _Allorallon_Repair <br />Show Num6cr fM) al lixfures <br />� nacnnowpre <br />Urinal <br />� Drinking Fou <br />— Floor drain <br />— Grease trap <br />Roof drains <br />Medical Gas <br />� Other: <br />� Other <br />I hereby cen�ty I�al i �ava reaC and eMamineC ��is apphwdon anE know ��e same lo Ce Irue and co�rect All provlsions ol laws antl orEinances goveming ��is ryPe ol work wd Ue mmpued <br />wnn wnclner speMmE netun ar nal e granting o: a OertnA aoes nol presv� i lo grve ¢ulhority �o violale or cancel I�e provision of any olher slale or lotal law regul,ling conslruction <br />Thal I a,uuJ�onze�y i�e' i e� is pwpetly Ic petlorm ��o work lorxli, n aDPlKdtian Is ma0e an01 wmply wii� Ihe Slate CONratlors law IB.27 RCW anE 29fi200A WAC. �! <br />// �� <br />�-C � 4-z�-i4 <br />Agei�� Slgnaturo Date <br />(ReviseC J201J) <br />