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� • <br /> PERMIT APPLICATION <br /> • BUILDING/MECHANICALIPLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 v✓v,rw.everettwa.org <br /> /� —�b —� <br /> SITE ADDRESS: S � 2E PROPERrY�x D3 � O. � PE Mir , � <br /> �f.5 <br /> LEGAL lor new construction� Shon PiaVsuOarvision Lot No (atlach copy ol icng legal Gescnp6on) <br /> OWNER � (� Phone/E�maii Zs��i Z�D�] / <br /> nddres5 80 T' /� C�ty/State/Z�p �/�i� �- 9�pe/� <br /> APPUCANT: Ownei Owner'sAgent �oniractar _ConVacloYSA9en� Tenanl�mmio�����eamewecc�senummmoo.�.ori000..oM��,:noso�ce� <br /> CONTRACTOR d--/\/ P(,/Y� ��- State L�c. # �} NyoN9�lU/t4�c��Y e�5 L�c.#Q�7�' <br /> naa�ess /(f r / . . L �ry � `T�3 Phone/Email 4���������p <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT p�� ������ <br /> L7 <br /> PhonelE-mail Z�T��CT'"�� <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK � v2 <br /> Cx�slmg Use of Bwlding HEAT SOURCE <br /> Pwposed Use of Ouddmg _ Gasy� Electnc_ Ol�er <br /> DuJding lype. fX Single Pamily _Dup�ex_Townhouse _Mul!i�Family _Commeraal <br /> Type of prolect. New �dddion Remodel Repair_T.I. _Sign_Sprinkler_Demoldion Change of Use <br /> JESCRIPTIONOFWORK(aac�;�onaispareprov�dedonrneDackl: ��J�.� �15nN�r G�ts �f'1/Z�I/�C� <br /> ltJfr►� ,V.p,r,�) �s �-uGNA� .5.� 59�'►'lE LOCf�Tio N � nJC'/ NY.K� � <br /> p�p> No� . <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Typo ol Project: _New_Addn ��loratlon_Repalr Type ol Pro�ecl: _New_Adtln _Altoratfon_Repair <br /> Shmv Num6w(p)ollixNres Show NumDcr(b)ol/i+tures <br /> NC -av hantlhng unds � Toilet <br /> Forced air 5yslems 6alhtub <br /> Gas pipmg Lavalory(wash hasin) <br /> � Waler heater Showcr <br /> Cas fueplace � Kitchen sink 3 disposal <br /> � Gas range I L'ishwasher <br /> Clothes dryer � Clothes washer <br /> Range hood Water heater <br /> Exhaust lan Sink(servi[elbadmoplelc) <br /> Heal pump � �ackllow preventer <br /> Umt heater � Unna1 <br /> � Boilcr Unnking Pountain <br /> Refngerahon � Flooi tlram <br /> Woodslove Grease Irao <br /> Ducimg � Roof drains <br /> � Other Medical Gas <br /> SPRINKLER I SUPPRESSION SYSTEM � O�her <br /> Number of Heads � Other. <br /> ,nereEy cen,ty Inal t neve renG anC eaaminetl Inrs apphcmion antl knaw me same lo Oe tiue antl couecl AU prov�sions ot laws on0 oiE�nBnces gooermng��is iype olwor*ui9 Ge comF��ed <br /> wnn wbetner spCfdieO ne�ein o�ncl ihe grenhng ot d permn tloes nal oresume Io qrve aulnarny to vro�ale or cancel Ine pmvision ol any olner slate or IOCrI la�.v retJulalug WnslmcUon <br /> mal I am aumonaea by me owner ol mis pmFeny to pertorm me xak lor wn¢�appi¢atlon is maae ana I wmply wnn ine 51a1c Convanas Law iB 27 RC W anC 196 200A WAC. <br /> OwnedAuQ orizeU Agent SlgnaWre � ' Oa�//� (Revised 3R0131 <br />