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I <br />r <br />PERMIT APPLICATION <br />BUILDING/MECHANICAUPLUMBING/SIGN/SPRINKLER/DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br />.nm rrAr1ONS ARE ACCEPTED FROM R AM TO 4 PNI "/--? — / Z <br />SITE ADDRESS: <br />O S Vi Pic', / ✓C <br />PROPERTY TAX R <br />PERMIT a <br />G <br />LEGAL for new constructan. Short Plal/wb(drV t Lot No _ (Ntarh copy of long legal descnptW) <br />OWNER "r,• ant '.l --miL.+q <br />Address rxrl Mile 1' �w1/f Mr <br />PbornelE-mall Z`11-22E-��ryS�/G <br />CtlyrState2p . Rh (✓' <br />APPLICANT:_ PAner _Owner's AgentContractor Contractofs Agent _Tenant lm,a1ov4a. bawam,�r,t aan a�orww �nne,e s.ol <br />CONTRACT/OR`r i1'11 C <br />iU <br />L BlLic. a fr 4 Llt y /7Licv. a <br />�2—Z3 <br />BuYBUSINESS <br />/'") <br />Address tv'*/IYd Phone/Ema'i� <br />67—OE30 <br />CONTACT FOR PERMITs. <br />XgJVV . <br />l C(LC I IM if PhoravE-mat D' 0/�•S"/SUS/ <br />BUILDING PERMIT APPLICATION <br />CONTRACT PRICE OF WORK WV, 000 <br />Existing Use of Building Rf1r'SF✓•1 r7 f HEAT SOURCE: <br />Proposed Use of Building /«nr^r Gas Electric Other — <br />Building type: _ Single Family _ Duplex _Townhouse _ Mulli-Family Y_ Commercial i <br />Type of r New Addition 1c Remodel Repair T.I. Sign Sprinkler Demolition Change or Use <br />DESCRIPTION OF WORK (adabionalspacepmviderlonmebaclt): <br />c.ey. Cc/to" tD L'F><f:'aY' /h IJ <br />MECHANICAL PERMIT APPLICATION <br />PLUMBING PERMIT ION <br />Type gPro)act: _Now _Addn _ARarsllral _R"Ir <br />Show Number dflrtwes <br />Type or Prood: _Now __AM ARot, <br />Show Nurrlew or RAtve <br />rbasm) <br />A/C — air handlingunits <br />Toilet <br />Forced airs stems <br />Bathtub <br />Gas piping <br />Lavatorywash <br />Water heater <br />Shower <br />Gas fireplace <br />KacMn sink 8 dle al <br />Gas range <br />Dishwasher <br />lixther; dryer <br />Clothes washer <br />R~ hood <br />Water heater <br />FithaullLfan <br />Sink servicelbar/m etc. <br />Heat um <br />Ba0flow preventer <br />I Unit heater <br />Urinal <br />Boiler <br />Drinking Fountain <br />RefrigerationFloor <br />drain <br />I Woodstove <br />Grease Irap <br />Ducti <br />Roof drains <br />Other <br />Medical Gas <br />SPRINKLER I SUPPRESSION SYSTEM <br />/ Other: o 'r)"k.nl7 <br />Number of Heads <br />Other: <br />NN <br />1 hereby cents that I have read and examined! Min appiva0on and know the same to be Ime and oolRfd. As provebns of ban and omnances governing this type of van Ira be umpked <br />Dort veremAgranting;er specheten or not The granof a pemM m does not presume to 9" suit" to Wlab or cv�l Me provelon of arty oTx ab"a or but low reaularim consMwtm <br />That I am anthorbed by the ovner of Mls property In pafbrm Me work for nhiclt appkuaon is made and I comp// v th Me Sfate Conbardon Law 1927 RCW and 296.200A WAC <br />IAWrodfed Agent Signature Date (Revised 62012) <br />l/C_ <br />