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PERMIT APP�ICATION <br /> BUtLDINGIMECHANICAL/PLUMBINGISiGNISPRINKLER/DEMOLITIAM <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 425-�57-8810 FAX d25-257-8857 www.everettwa.org <br /> �o -- z—�y <br /> s�ren�o3o33 qf''' Av2 S � � PROPERTYTAX�iOl030�00�19�j00 . P RMI C + ^� <br /> � <br /> LEGAL lar new consimclion�. Shoh PlaVsubdrvision Lot No._ (attach cop7 0l lang legal descnplion) OI7 Yf1� y.�+y� ,M�i <br /> J .� <br /> OWNER ROZ11/�G Ctl �lill PnoneiEmail VI!'� � S�I O��q��Lf • 0 <br /> :�aare55 $OS �6 �" STSE SufFG 10 � ory�s!atelZip M�11 Cr'P�Gk wA 9FS012 <br /> APPUCANT: Owner �Owne�sAyem _Contracior _ContracloYsAgenl Tenam����:ioro��ae.,��amrmco�se�:v<�r.o�w�e,uaa�.on�,mes�a:e� <br /> CONTRACTOR �-1 E m ���JRIJ 1�eS IY� C • Slate Lic. k �C C.� l� �90�i�ity Bus. Lic. # b�J S� . <br /> Atldre55 � 4 1 I 17r� �L � Phane/Ema�l <br /> TENANT BUSINESS NA�'E CONTACT FOR PERMIT <br /> SHI �A �..r�A �rrr am�h��lq�� @9Ma;l• � - <br /> Pnone/E-ma� <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK$ I I0� 00 a <br /> Existing Use of Building — NA ' � HEAT SOURCE� <br /> Proposetl Use of 8widing p�,/�N�P+ � ` s�'�J ��� _ <br /> 6— Gas Electnc_ Otner <br /> Building type: _Single Family _Duplez_Townhouse _Multi-Family �C Commeroal <br /> Type of projecL New Addition Remadel Repair T I _Sign._Sprinkler_Demolrtion_Change of Use <br /> DESCRIPTION OF WORK(add�tionai space p�cviaeqpn`th�e oacr,/ <br /> �en�c h t �►1-{UTA 0 f �G 1�� D lL�" . N O LInA�L�<.� � "r'L1.� S�ll L�4'e �I <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Prajecl: _New_AdCn _Alteration_ftepair Typr of Project: _New_Addn _Alleration_Ropair <br /> Show N�imber(qJ ol/ixfures ShowNumbcr(d)o/lixf�res <br /> A/C-air handling unils I Toitel <br /> � Forced aii systems ; Bathtub <br /> � Gas piping I Lavatory (wash basin) <br /> � Water healer I Sho�.ver <br /> Gas fireplace 1 Kuchen s�nk E disposal <br /> � Gas range D�shr�ashcr <br /> � Clothes dryer � Clol�es washer <br /> Ranye hood I Walen c�ater <br /> Fxhauslfan I Sini(servicelbadmaple�c.) <br /> Heat pump � 6ac4flow preventer <br /> Unit heater Unnal <br /> Boder � Drinking Fountain <br /> � Refrigeration Floordrain <br /> Woodslove I Grease trap <br /> Duc�ing � Rocf drains <br /> Other Med�cal Gas <br /> SPRINKLER ! SUPPRESSION SYSTEM oiner: <br /> Number of Heads I Other. <br /> I�erc0y ceNfy iral I�ave read and e.ammed Ih�.s appliation and know�he same lo Ce�me antl correct nll provmons o'laws anG atlinances govermng iMs lype al woih w�ll be wmp4ea <br /> wnh wneNer snecAiea nerein or not ine grantlng ol a permi�Coes not D'es•�rt:e to grve authomy 10 noiate or c�ncel Ihe p�o�ison of an/olher stale cr local law regutaling construcnon <br /> 7ha�1 am awnor y tn i i�is proDeny to petloRn iha work fo�wmcn app'�icaiien is maCe antl�compP�a5m me S�a1e Conlra:mrs La.r 18 P RCK'a.�E:96 20�A V:AC. <br /> � (v <br /> OwnedAul zed Agent Signaturo Uale (Revisetl3/101J) <br />