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� <br /> PERMIT AP�'LICATI�N <br /> BUILDING/MECHANICALIPLUMBING�,iIGNISPRIi�14CLER/DE�qOL9TION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everetri��a,org <br /> �.D9`"/ <br /> SITEADDRESS: PflOPERTviqXu ' P�E^MiJtt � _ O <br /> f� � ���� � <br /> LEGAL lor new con5!mclion: Shori PlaUsu60ivision Lo�No._ (alta�h mpy ol long Iegal deccnpiion) <br /> OWNER ���� ��1SV Phone/E-mail <br /> AdJress l30�1 391'� S e,�1 W A Q� Ci y/SlalelZip <br /> APPLICANT: Owner _Ov�ner'sAgen� _ConVatlor �onhatlofSAgen1 _TenaN�ncsip�mieaale•�c�olmntrniocmmovx�m�'oaoHcrvinmospacel '� <br /> CONTRACTOR g O U 1SYl " S�atc �_ic. # f,Q -p A City �us Lic. # p � <br /> 4a5 �3-OI$Z ��3Z"T- o0 <br /> Address '7a� ��J St(, ' S�1 �ga�� PhonelC-mail Yll R 1 a d e.�g � <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT �j <br /> Sieve, Ove.rway <br /> PhonelEmail ��.�-(�� �Z <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORKi J O�» <br /> Exis6ng Use o(Bwtding QG�pS H[AT SOURCE' <br />� Proposed Use af Building !PS� Gas� Eieclric_ Other____ <br /> Building type�. .�,LSmgle Famity _Duplex_Tovmhouse _MuIlrPamily _Commercial <br /> T�ype of project. New Addilion Remodel ��f2epair__.TJ. _Sign_Sprinkler___�emolition_Change of Use <br /> DESCRIPTION OF WORK(addrtiona�space p�o��ved on�hc baek/ <br /> FVf'A.Lt��, ��I �Ur^QNt� <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Typo ol Projeet: _,New_Addn _Alteretion__Repair Typo ol Project: _New_Addn _Altnration_Repair <br /> Shaw Num6cr(d)ol lixfuics Show Numbcr(p)ol lix6ucs <br /> NC�-air handling emis �fodet <br /> I Porced air syslerns � 8athlub <br /> Gas piping Lavatory(wash basin) <br /> Water heater I Shovmr <br /> � Gas lireplace � Kilchcn smk 2 disposal <br /> � Gas ran9c � Dishwasher <br /> � Clolhes dryer � Clo;hes washer <br /> Rang�hood Water heater <br /> f_xhaust lan Sink(servicelbar/mop/e�c� <br /> Heat pump � DackOow prevenler <br /> Unil hea�er Urinal <br /> Boilcr Drinking Pountain <br /> � ReGi9eralion � Roor drain <br /> Woodstove Grease Irap <br /> Uuc�ing I ��aof drains <br /> Olhcr Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM � Oiher <br /> Number o(Heads I Olhec <br /> 1 heie0y cerlAy I�at I havc read an0 eRammeJ Ihis appl�cauon antl know Ihe samc lo be Ime anE corrM.All pmvisions ol laws and mdinance;9aveming ih,lype ol wo�k will be compl�etl <br /> wn vmether:pec�ic�hercin or not T�e graNing ol a peimd Does nol presume l0 9ive au�honty to violate or w.�cel i�e D�ovision ol any oihu siaie or louil law rcguiming conslmcbon <br /> That 1 am: nhoiimtl by Ihe ownei ol lhis prope�ty�o pedorm Ihe work br which apDlicaliun is m��de and I comp��wilh I�o S�aie CaNratlois Law 10 2/RCW an0196 200A W�C. <br /> O��cf/���I�nrirrd A�mA Sir�nalurc — �� Dale (Rnviscd7/101JJ <br />