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� � <br /> PE��MIT APPLICATION <br /> BUILUING/MECHANIGAL/PLUMBING/SIGN/SPf�INKLER/L�EMOLITIQN <br /> CITY OF EVERETT PERD4IT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 �•�nv�v everettwa.org <br /> SITEADDRE55: PROPER7YTAXU P RfdlTa <br /> 3Z S�"' nn . ��z �c��.t� - <br /> LEGAL lor ne�+i construclien Shert PiaVsubCivis�or�J1SC.:�re- LC A�-� Lol No�[_7 (anach copy ol Icng iegal aescr�p'�on) <br /> OWNERS�QI�L�L Q AUC-•c_. t�.'�F�cS Pno���e-ra�� �Q2S) �iS 3- Z�i o� <br /> ('Zf�$ u FcJ yv�4�,1. �.�.a.� <br /> Address v� � �O 'J ' CitylSta�e/Lp ���� �/✓V� . Qj�JZU� <br /> APPLICANT:_Owner _Ovmer's Agent _Contraetor Conlyde�o�'S Pgenl ,Terdr,��m�m p�c.�to a ir-e�cimrsera ucn�ioc�rei�cCo..on mmo spazel <br /> CONTRACTOF�9�1�L l.�-. C ��-- 1 �_ � L. Slale Lic. ��zAl\ �QOSC� l� Gty Bus. Lic t�.l03'uQ.�a-3�e-d <br /> Address �J"P�-Vr �. Phone'Ema�l Sr�.1M � • <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT ��,J �A��-L <br /> �4��-) 350 •4�2 <br /> Phon2lE�ma�l <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Gws��ng Use of Bmlding HEAT SOURCE <br /> Proposed Use of Bwlding Gas_✓ Eiear�c__ Omer_ • <br /> Bu�ld�ng type �Sirgie Famdy _Dupiex_To:•:nheus= _f;7uIG-Family _Ccrr�meraal <br /> Typz o(pro�ect ✓Flev+ Adddion Remodel Repair_T I Sign_Spnnkler _Demolition __Change ol Use <br /> DESCRIPTION OF WORK l��ac'�ne�ai sPace;:rcv,aed c:�me bacK� <br /> �� �i,c� pw,�� Z- c� �i�w-�,� �3,�s�L � <br /> S tP.� o� aN'-dre- <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type ol Pro�ecl: ✓Ne�v_Adtln _Allcration_ftepair Type of Projecl: _New_�dtln _Alteration_Repair <br /> Sho�v Numbcr(k)ol fisfures ShowNum6cr(N)ollirfures <br /> NC-air handlmg uni�s .3 I TOilel <br /> � ferced air systems � Balhtub <br /> � Gas piping Lavatory(wash basin) <br /> Nlater heater I Sho�ver <br /> Gas Greplace � Kilchen sink.°.disposal <br /> _�_ Gas range I D�sh��-asher <br /> _�_�_ Clothesdryer ' _ Clotheswasher <br /> S I Range hood � V'Jaler healer <br /> Exhausl fan � I S�nk (servicelbadmop/etc) <br /> � Heal pump �— I (3ackflow prevenfr. <br /> I Unit healer i Urmat <br /> � � �oi��,� — Drinkmg FouNam <br /> .� � Refrigera�ion �- � Floor dram <br /> Woodstove I Grease trap � <br /> Ducling I Roof drains <br /> � O�her r' � Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM j other <br /> � NumherofHeads � Other <br /> Inerebycen.lyinall�ave�eatlanEexamineElhi;aOP���aiionandVnowlhezame!obelmea��mrrcct Allprovisionsollaxsandortlmancesgovernmgl�rslype0lwoikw.l�ecomp��e� <br /> ra:n a,�lelner speoGeC nrrei rnol 7ne gr�nling cl a pemtd eoes no1 C�esume lo glre au�nof,ly'o vio�a'e oi wrcel Ine pmvismn ol any clner s'ale or IOLtI ISrv regu:al�ngconsiracl!on <br /> Tnollanaum iie yi�r vn^ IlnisproFetlyloDerlorm�ne�wrlJarv.mchappi-cal�on�sma;feandlcmrpiywu��heSa'eCentraCorsLawI877RCYJanC2c6Z00AN/AC. / <br /> l � <br /> (� 20- 1 � <br /> OwncrlAu orized Agenl Signalure Oafe (Revised 340�J) <br />