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� • <br /> PERMIT APPLICATION <br /> BUiLDINGlMECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257•8857 Nrww.everettwa.org <br /> SITEADDRES: � Q' � � y` pROPERTYTAXfI PERfd1T# <br /> 'L32 + � <br /> /+ �S 0 � -01 <br /> LEGAL(or ne�v construction: Short PlaVsubdivisionl.ASG�C�1-a- PNL.�ti �o�No.�-1 (atlach copy ol long legal desn�plion) <br /> OWNERSF�,ptTl-�� 4(r�(= IC:_._ f�Or1A(-�,S Phon�/Email L{ZS` GS�� Zr'YiO� <br /> surrfc v a1ZU4�i� i,iA • c1`3ZGQ <br /> Address Z� . � �LV; Cil /S�ate/Zi <br /> APPLICANT:_Ownet _Owner'sAgenl Conlraclor ConlraclofsAgenl _Tenant(mosip�o.�,aeaieneroimnsenniommov„mrmaowc���mmosPoce� <br /> CONTRACTOR Sr4rrl.k (�,4Li f.-�� siaie u�.t� � - _ 3(ve� Cdy 8us. Lia#SEq7��i ;R <br /> ndtlress S�yN�L Phon?IEmail 5'�1M� <br /> TENANT BUSINESS NAME CONT.4CT FOR PERMIT �-GI�nJ UZ+t(,tFp _ <br /> Phonc�E-mau L4Lr� 3S C,-- dOG� <br /> BUILDING PERMIT APPLICAYION CONTRACT PRICE OF WORK <br /> Existing Use of Bmlding HEAT SOURCE: <br /> Proposed Use af Building Gas �eicctric Oiher <br /> �wltling lype: �Singie Family _Duplex_To�•mhouse t�4ulti�Family _Commeraal <br /> �yp^ of projzd: ✓Nev� ___Addition __Remodel _Repair_TJ. __ Sign ___Sprinkler_Demohtion Change ot Use <br /> DESCRIPTION OF WORK(anmherral space provitletl on Ihe h�ce)�. <br /> � �`l � �LA�.�I Z �A'L � A2.�a�ji� . �3f�S� � � <br /> RB1yC�g- OO <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> 7ypx of P�ojecC _New__Atldn _AlMralian_Repair Type of Project: _New_Addn _Nleralion_Repalr <br /> Show Num6cr/M)ol l/xfuic,^ Show Num6cr(p)oI firWres <br /> — NC-air handling unils _3 � Toilet <br /> I Forced air syslem� Z T t3alhtub <br /> Gas pipin9 Lavatory(wash 6isin) <br /> \ Water healer � � Shower �� <br /> Ga,freplace � � Kdchen,ink&dispusal <br /> � Gas ran9e Dishwasher "-- <br /> 1 I Clothes dryer I Clcihes washer <br /> t i Range�wd � Water healcr <br /> � [xhau,t lan I Sink (scrvicc/badmop/etc) <br /> � Hea�purnp '— � BackOow �revenler <br /> — � Umt heatcr _ I Urinal <br /> — I Liailer I]rinking PouNain <br /> — � Refngeralion — �loo� Arain <br /> -- i Woodsiovc � <br />, Duchn9 — I Grease Irap . <br /> -- ( i9 I Root drain, <br /> � Olher — i Medical Gas � <br /> SPRINKLER / SUPPRES510N SYSTEM — � Other <br /> Numbcr of licads '� � <br /> -- _ I Olher. <br /> I Imrcby ecnAy Ihol I h�ne reeJ and cremmne�i Ihis appticali�n an�]know Iho;ama lo be�nm an�calftd.All provisiom,ul lave:and ominancez govrrnin9lhis lypn ol woM.vri br.mmp5ed <br /> �vBh v:�etOer epe<KeG�einn o�nol.The qiariliug nl a peRnit does nni prinumo to 9rvo avlhnrty lo vloiale or corccl Ihe provr.ion al any aiher sla;o or loe�l iaH regWan�y¢�i invc����n <br /> Thal I am. it�onr cf by II ov�ner 1 tl�ig pmperly lo palmm the fvolR fo�whmh appl¢alion�;mnne ane I romnly wilh I�e Sble Conlratloi�law 10 7712C W an�296 7fqp\VAt; <br /> � - Z � - I � �/ <br /> Own r AuthorimJ Agent Siynatura Dale (l7r,vised JR017) � <br />