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PERMIT APPLICATION <br />BUILDiNG/MECHANICALIPLUMBING/�IGN/SPRINKLER/DEMOLI'FION <br />CITY OF EVERETT P�RMIT SERVICES <br />3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.evereitwa.org <br />ADDRESS: n�� � ,^ �L <br />x zu, <br />RTY <br />r <br />3 �i3_ <br />�� <br />in�-�� <br />�L for nev+conslruclion: Short PlaUsubdivisian Lot No._ (����ch topy ol long Iegai description) <br />ER /'T/,f}7\% TG.SI�'YA" PhonC�C�mail �(25-353-15� <br />S <br />�a��55 $({a-O �i� ��— W la�yisi�i�rz�P �V�''1T, (.11A- ���� <br />PPLICANT:_O�vner _OwnersAgen� �Contracier __Contradoi'sAgenl _1"enanlln�,:ic�o�+�caicn�rci�c�:rmvcnms�.n:rioaaw��w:�me:F,,�r� <br />nr,ironrmo n,,tia, � l�rG �/ 151�i� c�' TT�r. State �ic. nDA4�i�/lPFt�l�-I��i�2Q Clly BUS. �iC. r:��� /� ( <br />� <br />Phone/Em. il <br />TENANT OUSINESS NAME CONTAG � FOR PERMiT Q�, ,� 2� �� <br />�'-'Y �[/ <br />Phonc/E-mail %�'✓��%S�'7(G <br />BUILDING PERMIT APPLICATOON CONTRACT PRICE OF WORK <br />Exisling Use of Ouilding HEAT SOURCE�. <br />Proposed Use of Building Gas___ Eicclric __ Oiher_ <br />Ouilding type� _QLSinyle Family� _ Duplex _Townhouse _ Multi-Family _ Commercial <br />Type ol pioiecl New Addil�on _ Remodel=_ _ Repair __ T.I. _ Sign _ Sprinkler __D•�mn!ition _ChanGe o( Use _ <br />�ESCRIPTIONOFWORK(adU�uenaisn�;ceprovidedontnr,back) QEP��E �Xl�n�q I%✓�F (�{/��_ <br />�eV I CE �py✓l '(7'%� G('ll4 i� e-�L -� Y:}e, I�JL S� • <br />0 <br />M,� :HANICAL PFitMIT A�PLICATION <br />olProje�:: _Nc�v_ Addn __Altcralion__Rcpair <br />Show flumbrr (N' ol iixfurc; <br />� NC �- air handliny unils <br />I Forced air svstems <br />Water <br />tiood <br />[xha <br />SPRINKLER/SUPPRESSI <br />� Numbcr of f leads <br />PLUMBING PERMII APPLICATpON <br />pcofProJecl; _New_Addn _Alteration_Rcpair <br />Sho�v Num6cr (p) o! lix(ures <br />ClotLes <br />Medical Gas <br />Olher (�✓t�• <br />Other <br />dis <br />Ira�icbyrrihtylhallhmeieaJnndexnminedlhl;:.pplicnlion�mdknowlhesamelo6elrveanAcorrecl AUpmvi:ion,ollaw;andoidinan<esgoveinin9lhislypuolvmikwdlhecompP,ed <br />v::l� wlielher speuficd �e« in or nol. The grantin9 0l n pcimd tloe; nN presume lo gNe:unhor�ly lo violale or uincel ll�e pm�nsion ol any o1Acr slale or local l;rx icgulalin9 wnsW tlion <br />I nal I am a�.nhorized Uy Ihe owner ol ihis prupriiy lo pMorm the wo�k Por which:�pplication is matle antl I comDly wah Ine Slate CoNiaclou I.aui i�.77 Rf,v! and 296 2o0A WAC <br />� � - -- 3��1-� <br />OvmerlAuj/ ori�ed AgeN Signa�ure Dale fRevr,cJJ?07JJ <br />