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�J <br />� <br />PERMIT APPLICATION <br />BUILUING/MECHANICAL/PLUMBINGISIGN/SPRINKLERIDEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa org <br />11--19-1� <br />SITE ADDRESS:�'yr � � �j , /n /1 �� S-E <br />I> J i � F-t <br />lor new cons�ruclion: Short Pla <br />� CLa `l� l� <br />Sl�i � � �!-� <br />rnx a <br />No,_ (attach copy ol :ong Ic9ai descnption) <br />�� ��� - .�SS - �� <br />P C�V-i V-c��, 1'�-�%`i _ i <br />Owner _Owner'sngent __CoNraelor __Contractor'sAgent Tenant�rc�:icm��e�aio:rero�con:e��inomnwvH�ermeowc�xmmo:;.,-.,� <br />� O 1(/l JJ <br />oZ� � ��- <br />�5��� <br />BUILDCNG PERMIT APPLICATION <br />StateLic/.^fl �,... \n <br />` V � I�C� I <br />Phone/Finail � <br />CONTACT FOR PERMIT <br />PhanelG�m,il <br />CONTRACT PRICE OF WORK <br />Gxishng Use of �uildmg ___ � <br />Proposed Use of�uilding <br />Building lype�. �� Single Family _ Duple� _Townhouse _ Mulli-Family _ Commercial <br />Type o( pro�ecf New _ Adddion � Remodel _ Repair _ T.I. ___ Sign ___Sprinkle�� <br />DESCRIPTION OF WORK (add�nonal sp•�ce piavided on Ihe back) . <br />N e,cni �as I � � e <br />MECHANICAL PERMIT APPLICATION <br />olPro�ect: _New_Addn _Altcralion_Repair <br />Show Numbcr (a) of fixtures <br />!VC — alr handhnp units <br />Porced air systems <br />Gas piping <br />Water healer <br />Gas fireplace <br />Gas range <br />Ciolhes dryer <br />Range hood <br />Fxhaus�(an <br />lieat purnp <br />Uni� h�ater <br />Boiicr <br />Refnyeration <br />Woodstove <br />Ducling <br />Olhcr <br />! SUPP�tESSION SYSTEM <br />Numbr.r o� Heads <br />'�_ Ciry Bus. Lic # <br />�' � �"— C <br />SOURCE <br />o� Use <br />PLUMBING PERMIT APPLICATION <br />olProject: _New_Addn _Allcratian_Repair <br />Show Numbcr (tfJ oI lix(urc.^ <br />Todel <br />Bathtub <br />sink <br />�her <br />floor drain <br />Grcase Irap <br />Roof drains <br />Medical Gas <br />Othm <br />Olhcr <br />I hereby cerLly Ihnl 1 navo mad antl e�anunetl T; appLrnipn antl knu.v Ihe ;umo lo De Ime ontl wm:cl All V�ovisions al law; uM oidinances govemin9 �his 1>e al wuik wfl he eomplred <br />wd� w�einet spectlm0 �crein or nol i�c gr�nl nq ol a pertnii Goe; nol presume lo yrvC aulhorily �o vioialo or r.�n<el I�e D�ovision ol dnV ol�er s1a19 ur locdl law ieyulatiny conslNqion <br />Th'il 1 nm auihonzctl Dy I�e wmer ol l� , propr"/ �o ped^rm I�e work lof vAiich:ippl¢ahon i; made on0l mmply wAh Iha Slalc Cunlrado , Lax 1fl 27 RCV✓anrl 19G 2G9A WAC <br />-�%,u��L _.� ���--J ��-i� " a �% <br />t� , <br />OwnedAulhorized llgen! Signaturc Dale (Rewsed 9/J017/ <br />w <br />'4 � <br />( Cr/ <br />