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� � <br /> PERMIT APPLICATION <br /> BUILDINGIMECHANICA�_IPLUMBING/SIGN/SPRINKLERIDEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St , Everett, WA 98201 425-257-9810 FAX 425-257-8857 vn�nv evere`,Rva org <br /> G� 16- 1U <br /> SITEADDRE55� PNOPERiYTA%d P �"� p <br /> ' �� `L � 51 � `z ` 2`c �0-�z <br /> LECAUcr new eenslr�U�o�+ Sh:�n P�aLsu00rv�sion Lcl Ho i.i:�nch ccpy o7long ieual descn����) <br /> Y ry�� <br /> OWNER '�'r[[�1C?J .�7 G �?N��j�'fj ,t. 1 ) l�17 . Phone/Ema�.i <br /> ��cc�ess �. )C � �-_ J � Gry�Siaie2�p . � ^ �} -1 0� <br /> , 1 <br /> APPLICANT: �Owncr _O,vncr'sPgc:l __Con;�ac:o� _CcnhadorSPgcri _Tenarlh-,mr��ao.,i•.•,..m.�-u,i+:�.�ndo.oe.�cco..c�n�rns;accl <br /> CONTRACTOR , � (` State I.ic # Cdy Bus L�c # <br /> aya�es; ��j'�/l�G '-t ^ � Z Phore�Ema�i ��.-i . 'J'�J� � 'J-i �L� <br /> TENANT DUSINESS NAf�1E CONTACT POR PERMIT 3fj h n. �� � R <br /> �J i C`1� �`Cc;Nr���iZ <br /> ,,.,..._E�,�� ��5_ 3'3�f, 59_"',`1 <br /> BUILDING PER�VIIT APPLICATION CONTRACT PRICL OF WORK _ <br /> E,�.st�rg Use ol F3w'dvg__ _ __ __ _—_— _ HEAT SOURCE <br /> � - ` C Gas__ [Ieclnc Olher <br /> Preccsen Use o(/6udo;rg_jLL �1 17,y�_�_ — — <br /> iE3�•�,cg,yFe y Sirg'��e Fa!n�!y _ Cup!ea__Tov;nhouse _ �.iWu-Fam.�y _Comme�c�al <br /> t,��c n!p�o�ed Nc:+ Addn�cn _ Remodel _ Renair 1 � _Sign_Sp��nMier _�emclAion__Change ol Use � <br /> DESCRIPTION OF WORK i:�.�!�c�ai space p�avaeeon rne ea:�; <br /> `fi� P,GbF <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERi�'!IT APPLICATION <br /> Type of Pro�ecl: _Ne.v__Addn _Alleration__Repair Type ol Pro�ecl�. __New_Addn _Alte�alion_ Repair <br /> Shmv Num6cr(a)ol/ixfures Show NumDer(N)ol6xfure5 <br /> � A,'C-air handling unds I iodel <br /> � Paiccd ait systems � C�aUitub <br /> � Gas prpinq � Lavatory(wash Lasm) <br /> Waten c�atcr � Sho�.ver <br /> Gas fi�eplace I Kdchen sink 3 Aisposal <br /> Gas r,nr,e Oishwashcr ___ <br /> I Clolhes Aryer ( Clothes washer __ <br /> ! Range hootl Waler heater _ <br /> � Erhaust lan I Sink(service/barlmoplelc) __ <br /> � Heat Pump � Oackllow preveNer <br /> � Umt heafer � Unnal <br /> � L3oiler Dnnking Fountain <br /> � RCfngerBlion � Floor dram <br /> I N'oudslove Grrasc Irap <br /> Duch^9 � Rool drams <br /> I ���;,_� Metlical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM j Other <br /> NumberofNeads � Olher <br /> I�e�c�y ce��''y I^al I'�a�e iead JnE e�amined lhi;ppp4cal:Jn and Y norv fie same la Ue WC and cortecl AX provis�ons ol laws 3ntl OtEin2ncM gOv2m��g!h'.s tyFe of v.9t4 r.11 pe comp'Cd <br /> �.wm�meiner speofic��eiem or�c� Tne giaoLng el a Oermn does net pmsume lo gne aul�o�dY lo.m�ate o�cacal me Grovinon ol any oIDer stal^or b:al'z:.�e;�.h�—:c.-�.•,�.._... <br /> 7�d1 amauthOniCODyl�eOr.ncrallp�spiape�ylopertotml�ew0iklolaMiChapp!cal�onismaCe2r.dlcamplywtlhl�e5ta'eCcnVe[�CrilawiB27PCYr'anl:SG:C-0S::+C <br /> > �� p /� D/ <br /> .�---iC �. �,� l y� � � <br /> Owned�u�ionzed Agent Signatmc �ate jl.e�iseh 2;70+3) <br />