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� � <br /> PERMIT APPLICATION <br /> BUILDINGIMECHANICALIPLUMBINGISIGNISPRINKLERIDEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar SL, Everett, WA 98201 -425-?57-8810— FAX 425-257-8857 — viww.everettwa.or <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �- a-��I <br /> SITE ADDRESS: �I� PROPERTY TAX p PERM�a � <br /> 5 <br /> LEGAL`or new eenslNcbon. Shon P�ausubOrvson Lel No (aUac9 coDy cl lono Ieya�Cescn�or� <br /> OWNER ? C . � PnoneiE-mad �/ZS� 23q— <br /> nteress � �l��U2 ��A c� c��y�5izierz�o LVE2� �� <br /> CONTRACTOR l�(�IZG^ — S�M� � Ntst(Z_AC L 8 I Lic N C—II�SSOZZO� <br /> � <br /> t�deress `J�I20 t�/�G� IG Prone;Emad �-{ZS) Z52 -3�I <br /> TENANT BU INE NAME NTA T F R PERMIT <br /> KtN Si-� <br /> chore,�E.ma��l ' v�$2�G4(.�SSNiUtt.CC7t�1 <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK t I��DOd <br /> EsistingUseolBwlding sf1Q. HEATSOURCE� <br /> Propo5edU5eofBwlding `J{� (t�D �,�11+NGL� Gas_ Erecvr _ Oi^er___ <br /> Bu�iCmg type: 'F Smgle Fam�ly _Dup!en_Townhouse _MuIU-Famiy _Comme�ua! <br /> Type o`pro�ecl�. _New _Adddion _Remodel _Repair�T.I._Sign_Sprinkf�ler_Demoliticn_Change of Use <br /> DeScnptionofWork(adtlmonaispecop�ovitlodonlhoOatkJ; pDJ 'Z ���JN l-�iw� ('...-�� -fc> �pST���� f-1J�5� <br /> LJr��,1 ly,' Qvl� �roli- \.1ib� LC-i . �JN�t <br /> Nave you started warking without a permit7 _YES K- NO <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATIUN <br /> Typc ol ProJecC �._New_Addn _Alterallon_Repalr Typu ol Pro�oct: ,New_Adtln _Alteratlon_Repair <br /> Show Numbnr/N)af llxfures Show Numbar(p)alllrtures <br /> AIC—a��r hanCunq unds Totlel <br /> Forced av s slems �athtub <br /> Gas ���nq I Lavato wash bas�n <br /> W ater heater Shower <br /> Gas fire Iacc Kilchen sink 8 dis osal <br /> Gas ran e D�shwasher <br /> Clothas C er Ciothes washer <br /> Ran ehood Waterheater <br /> Fxhaust fan Smk serv�celb.;rlmo letc. <br /> Heat um �ach0oc+ revenler <br /> Und hcater Urinal <br /> Bodor Drinkm Fountain <br /> Refn eralmn Flnor drain <br /> WooCslwe � Grease Ira <br /> Dur,tinr Rool dra�rs <br /> Other ��ted�cai Gas <br /> SPRINKLER I SUPPRESSION SYSTEM Other. <br /> Number of Heads Other. <br /> I nereDy cerldy ihal I have read and examine0 I0�5 apDliwlion anC know Ihe same lo be Irue an0 cortect Au orovisions oi laws ana ordinances govermng <br /> Ihis lype of wv�k w�ll be compi�ed wdh whelhe�speufietl herein or nol.The granUng of a permd Coes nol Oresume to grve aW�ordy to v:oiaie or cance! <br /> Ihe provision ol any iher 51ate or ie �•�qulating conslrucbon or IM1e pedortnance ol consiruction.T�al I am aulhorand py;�e ov,ner o�Ih,prcpery <br /> �o prfortn Ihe �or whic� Imalior�is made arJ I com0ly wi�h Ihe S�ale ConlraUois Law 18.27 RLW and 796100 WAC <br /> � -2� -r 3 <br /> OwnerlAuthor zetl Agent Slgnature Dale iRnv�sen 2'70i�) <br />