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PERMIT APPLICATION <br />BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.evereK7(�ttwa.org %% <br />n conua eu Tn A PM _6 —/ `� <br />PROPERTY TAX# <br />PROPERTY <br />P�MIi # <br />ADDRESS: Ord e W <br />-7 QOaUL op <br />U J <br />Lot No (attach copy of long legal description) <br />LEGAL for new consbuchon Shon Plat1subdlvislon _ <br />aOU 84q &qq-1 4Lob q7I i <br />OWNER (,t)I 1 I 1 A r rl -e PhonelE-mail <br />"ro 9 v r-t�i- WA-g82o3 L)SPn�ro.rxncd} f <br />Address 5-oa� 3 rc Ave v CnyrS'Z, <br />APPLICANT: L�,bAner Owners Agent _Contractor _Contractor's Aa,! _Tenant m th.,r'<I <br />NNc. <br />KSCOEBuscli.LaiOC[# <br />-:.. n>-!. r L81Lic.#r y02-1.K-$ <br />CONTRACTORGr <br />/,� //// ' <br />ntldress 133�43 �C�rl/nfr-� N� ""`"'nJlll-e f07l Phonelt.rml 1AXf l�"1'I-y4 <br />CONTACT FOR PERMIT <br />TENANT BUSINESS NAME <br />'lotp GZJ� 13�is <br />PhonelE-mid S�n,Cv rCAYt,It [I`'Ey-•' to G.�oO- C.0 <br />BUILDING PERMIT APPLICATION CONTRACT PiJrOF ill <br />rfSp� of nin C-1 HEAT SOURCE. <br />Existing Use of Building — <br />I V. Other_ <br />Proposed Use of Building ri6«+e�� Gas. Electnc_ <br />Building type: Single Family —Duplex _Townhouse _ Multi -Family _ Commercial <br />T.I. Slgn of Use <br />Type of project: _ New _ Addition _✓Remodel _Repair _ _ __Sprmkler _Demolition_Change <br />DESCRIPTION OF WORK (additional space provided on the back): <br />G,OL✓ov- FtynOA?'( lM'o MOi�t!-in -IAW/ <br />PLUMBING PERMIT APPLICATION <br />MECHANICAL PERMIT APPLICATION <br />Type of Project: _Alteration _Repair <br />Type of ProJoct _New__Addn _Alteration _Repair <br />_New_Audn <br />Show Number (#) o/fi <br />Show Number (#) or futures <br />Toilet <br />j A/C - air handling units <br />1 Bathtub <br />Forced airs stems <br />Lavatory (wash basin) <br />I Gas piping <br />_ <br />Shower <br />Water heater <br />f _I <br />Kitchen sink & dsposal <br />Dishwasher <br />Gas fireplace <br />Gas range _ <br />--- <br />1 Clothes washer <br />I Clothes dryer <br />_ <br />Water heater <br />Ran a hood <br />_ -_ <br />I Sink (servicelbarlmopletc.) <br />Exhaust fan <br />BackRow preventer <br />Heat pump <br />I Urinal <br />Unit heater <br />Drinkin Fountain <br />Boiler <br />I Floor drain <br />Refri eration <br />Grease trap <br />Woodslove <br />Roof drains <br />Ducting <br />Medical Gas <br />Other_ <br />SPRINKLER I SUPPRESSION SYSTEM <br />Other <br />Number of Heads <br />Other: <br />I hereby endy llim I have read and examhred tilts appitcabon and know the same to be true and correct. All provisions of lavrs and ordmmaceb govemmg the type of work will be compled <br />war MoNer specified herein or not. The granting of a permit does not presume to give authority to violate or cancel me provisan of any other state or local law regulalmg conslmction <br />That I am authorized by the owner of this propery to perform me work for whKh epplicatan is made and l compy will the State Contractors Law 18.27 RCW and 296 200A WAC. <br />' L —1� <br />t - J /1 <br />N. I � -7 I 1 C) I12 (Revised 62012) <br />Ow 1Authonxed Agent Signature Date <br />