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�ERMIT APPLICATI� <br /> BUILDING/MECHANICAL/PLUMBINGISIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., ����rett, WA 98201 425-257-8810 FAX 425-257-8857 wUnv.evereltwa.org <br /> 6 -01 - �5 <br /> SITEA DRESS: �` �� I/ '^� . PNOPERTYTAI(N P RM1��T� oI <br /> V� <br /> LEGAL lor ne�v constmclion: Short Pla� u6division Lol No._ (aflach copy of long le9al descripli�n) <br /> OWNER Qu � � PhonM6mail . �VN��I.. ✓1� ' �-�� <br /> nddress � 1�" � � � Ciry�Statc2ip �.�j�/ VV1� (�(/ <br /> APPLICANT:�Owner _Owner'sAyenl _Contiadur _Conlraclor'sAgenl _TenaN(m�.�v�o.:aoairnrroironsannraminco.nerioaowoninine:v��-�1 <br /> CONTRACTOR Oy� � State Lic. # K dy Ous. Lic. # <br /> AJdres; ��� Phonc/Gmal IV` <br /> � _ CONTACT FOR PERMIT n VJU�Q ��' <br /> `� � r� I/ � <br /> �" /� Y�1�Lt <br /> Phone/[-mail �-�(y� �"I � <br /> BUILDING PERt�. APPLICATION CONTRACT PRICE OF WORK I GUD <br /> Exis�mg Use o1 Buildiny_��� 1 _ HEAT SOURCE�. <br /> Proposetl Use of Butlding�_ .� �Gl'U��a cas_ [iectnoVL omer <br /> f3wlding type. �Single Famity _Duplex_Townhyo,�use _Mulli-Pamily _Commercial <br /> Type of projecC New _Addition �iemotlel y�Repair_TJ.__Sign_Sprinkler_Demulit:�n_Changc of Usc <br /> DESCRIPTION OF WORK(add�nona�spar.e pmv�ved on me back)' <br /> ������ <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> 7ypc ol Pwjed: _New_Atldn _Aileration__Repair Typc ol Pmjec�. _New_Addn _Allcration_Repa�r <br /> Show Numbcr(p)o!lixturcs Shaw Nwnbcr(NJ ol/ixfurcs <br /> A/C- air hantlhny units Toilcl <br /> Forced an systems _ Bathlub <br /> Gas p:piny Lavalory(wash basin) <br /> --�Walen c�atcr Shovrer <br /> Gas Irteplace Kdchen sink&deposai <br /> Gas ranc,c Dishwasher -- <br /> Clolhcs dryer Clothes washcr ___ <br /> KanU�'liood '_ Walcn c�aler <br /> E.haust lan _ Sink(servicelb:rt/moplelc) <br /> Heal pmnU —�� - Backflow preventr.i (inside bidg) <br /> Untl hea�cr Unnal <br /> Uoiler Dunkinq PouNain <br /> Rcln9crauon � hloordram _ <br /> � Woodslova ----__ Grcase Irap— <br /> � Uuctinr�-- __ _ RoO�drains __ <br /> --�—Olhei --- — --- Medical Gas <br /> SPRINKLER I SUPPRESSION SYSTEM Other _ <br /> Numbcr nf Hr.ads Other ----- — - <br /> I hcwby certdy I�al I�om read:�nd e.im�neE I��s appYcat:nn and kn4.v Ilm same lo Oe Irue an�coned All p�ovisiuns ol laws nntl oiAmante;governmp Ihr,lppe ol wo�k wAI�r.cumpl'c� <br /> vuih whtlhei sproted here�m m�nl Ihe 9ranLn9 0l a pCrmA Dor:no�pmsumr.to qrve a�dbonly lo vtol,ile o�r�ncel Ihe p�ovi.�on ol:iny ol�er:I:+Ie or local lnw rC9�da6n9 conslmGion <br /> Ih�tl IJ"�'�''wlhovc�f GY Inc ovmc�ol I�i:prnprtly lo pedonn IAr wmk lot w�rth a iLcali n a madC an��mmply vni�Ihe Slale CoNrarloiti l arv IB?7 Hf.W an�t J9ti ZCOA WAC <br /> ���1 _Jf �/"���__ _'_ - '_���� (kCviscd420161 <br /> OvmmlTur17ronzcA Aqent Su �ahuc Datr. <br />