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ioio�/.oi� xuc is: ss rnx ___ _ _ 0ooi/ooz <br /> PERMIT APPLICATION <br /> BUILDI NG/MECHANICALIPLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar Sl.. Everett, WA 98201 425•257-8810 FAX 425-257-8857 www.ever ttwa.porg <br /> APPLICATIONS ARE AGCEPTE�FROM 8 AM TO 4 PM �� `I 1 `'I� <br /> SITE ADDRESS: PROPERTVTA%N ERMIT <br /> -4-Yv, r�. Oo 80 d 9 0� `1 �- <br /> LEG/�L lor new constmaion�. S�crt Plavsubdroisicn Lot No._ (anach copY ol long legal Aesa�ptWn) <br /> OWNER t'p��'"1 1"�, P�Onc/[�mail a0 '3 S' �0 .7�� <br /> A��,as= 1�o �,o�-eJ �av� �,�Y,S��t�Z�o Ev ++ �A q 20 <br /> APPLICANT: Owner Ow�efsAgent �C Contractor Cw�ratlofsAgen� Tenani(m�.�nwwaa�wrordconsminvm¢ewiuuao..+ann••>•ui <br /> CONTRACTOR 1�. L 8 I Lie.# COE Bus.Lie.#O <br /> A�Cress 13y PhonelEmail �� � <br /> TENANT�USINE55 NAME CONTACT FOR PERMI <br /> - �� aocn-�t-tg►8 <br /> P�ene�E-maJ aahl bne +�t�+w��h�f' • <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK �9�1 CJa <br /> Exi5ling Usc ot Building HFJ�T SOURCE <br /> Pwposed Use of Duilding Gas L( Eieclrm_ Otner <br /> Buildino rypo: ��Single Famity _Dupiez_Townhouse _Multi-Family _Commercial <br /> T e of ro"ect: New Addition Remodel _Repair T.I. Si n S rinkler_Demolilion_Chan e of Use <br /> DESCRIPTIONOFWORK(aCdi;iona�space�.vodoedonrnebacA/: ;� p_r 1t� <br /> rep�o,c.e 9as �i�r-►�ace ovul, wa,�le.r- hQ.a�-r; t rtv <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type ol Projoce _New_Addn _l+Iteralion_Repalr Type of ProJecC _Naw_Atldn _Alterallon_Repalr <br /> Shou�Number�a)ol linuros Sbaw NumGer(p)ol Or0 ics <br /> A�C—air handlma uni�5 Toilet <br /> Forcetl air s stems �athtub <br /> Gas pipin Lavalo (wash hasin) <br /> Water heater Shower <br /> - � I Gas hre lace Kilchen sink 8 dis osal <br /> � Gas�ango � �ishwasher <br /> Clothes tl er I Clothes washer <br /> Ran e hood Waler healor <br /> Ezhaust fan Sink servicePoadmo /etc. <br /> Heat ump Backflow pmventer <br /> Umt heater Urinal <br /> 6oiler Drinking Founlain <br /> Refn eiation Floordrain <br /> Wootlstove Giease lrap <br /> Ductina Root drein5 <br /> O;her Nedical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM other. <br /> Number of Heads Other. <br /> I liereby wtlAy�t�ai i nave rcaa antl e+em»e�Iltls aoG�Kalion nnJ know V�o tame ta pe true ena oarzttL All pmvisiom d lews ana orJinnncns Bovemhp Ub tyL'e of woik wJl be wmpce� <br /> wGh wimNer speufrE haiein a nol.Tne 9�untinp ol e pemml Coes not Wesumn to pl:e au�nonry Ie r:W ie or rnncel Ine prm'�skn ol any olner 9oie or loul law mpulainq con�tmcfon <br /> T�al I am eWhMxeO�Y��e umer al Nb p�o0e�y tu petlortn Ina waA Iw whkh opPlcatmn is mave en�I ccm�ry w41i Ino Slele ConVa�lors law 10.2]HCYJ e^4 2:6.208A WhC. <br /> /������ /o -.2/L <br /> Own r ut onze ABent5lgnature Dale (Fevrsetl6/.01:) <br />