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�ERMIT APPLICATI� <br /> BUILDING/MECHANICALIPLUMBINGlSIGN/SPRINKLERlDEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 wvnv.everethva.org <br /> SITE AD�RESS: PROPERTY TAX tl PERMIT# <br /> 8 / (2-(�, d� D/ DD ��3UDoD 22o p � - <br /> LEGAL for nev+conslruction: Short PlaVsubdivision Lot No.__ (atlach copy o�long Iegal description) <br /> OWNER � � l L PhonelE-mail <br /> Addres; �3 2 � (/,� (,(� Cily/5ta�c/Zip j/ � <br /> APPLICANT:_O�vner _Ov+ner'sAgeni _CoNracior �C�n�f�t�or'SF9enl _TenBntlmu.lprov��oaieneroiconunuwmmeonnerloa.��sohmmespace) <br /> CONTRACTOR }2� %S G CD�(JS/. State Lic. S ��t"L 79/v G/(�'Q3�j Gity �us. Lic. N <br /> � ��� �� � ✓� 1'rc ra<n/1� ' • 7 <br /> �dtlress Phone/Email��, p, 9��. � . L <br /> CONTACT FOR PERMIT <br /> /h�fh2i5 R�9-�r P�f�S f�95 / <br /> Pnone�E-in�i��r0 4��'b �fSJ`� Ihl2�'i5v✓aC � �f(• 4l'� <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK J��� <br /> Existing Use of Building _ HEAT SOUF.CE: <br /> Praposed Use of 6uilding Gas_ eiectr�c_ Other_ I <br /> building type�. __Single Family _Duplex_Townhouse _Multi-Family _Commeroiai I <br /> Type of projec�' New Adtlition Remodel _Repair_T L_Sign_Sprinkler_Denolition_Chanae of Use _ <br /> DESC RIPTION OF WORK(add�nonal spare p�o+ided on the back): ` / �(� <br /> -�'P�,n�,��� GUI�-�e-�G�alv� /kvn� `fb /'BS�G�-w'�'� 5��(� � 7"�/ <br /> �v_.---. <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPIiCATION <br /> Type ol Project: __New_Addn _Alteration_Repair Type of Projeet: _New_Addn _Alteration_Repair <br /> ShowNurnber(H)ollixfures ShowNumecr(N)o/(ixfures __ <br /> A/C—airhandlingunils � _ Toilet <br /> Forced air systems HaB��ub <br /> Gas Piping I.avatory(wrish ba�in) <br /> Water heafer � Shower ` <br /> Gas lueplace ` Kilchen sink&disp�:al _�_ <br /> Gas rangc Dishwasher __�__ <br /> Clolhes dryer Clofhes washer <br /> Ramge hood Wa�en c�ater <br /> Exhausl lan Sink (se.rvice/barimopletc ) <br /> lieal purnp [3ackflnw prcveNer jins��tle bldg) <br /> Uni� heater Unnal <br /> Ooiler brmking Fountain <br /> Relrigeralion Flaor drmn <br /> L_ Woodsiovc _-- --- - Grcasc traP - <br /> � Ductiny Rool drains <br /> � Other- ---- ---- �— Medical Gas <br /> SPRINKLER / SiJPPRE5S10N SYSTEM Olher. _ _ <br /> -.- �---. Numbcr nf I Irads ---- Ofher. ,. <br /> �hciaby cenily inal I h:rve re:�d ontl o�aminerl lq,;ipplicahon a�ul Ynow IOe:ame�o he Irue antl cone.l A!I provisions ol I,l��i,and urdmance,9overning Ihi;lype ol wmk.v!I be compbed <br /> •nlh whetlre�:pecAled P.ere�n or i:�I.Thr pr.mhnq o'n permil Eces nol pre,ume l0 9rve aitlhonly Ic molale or w.�cN I�e p�ovision cl any olhet:ta'e ot Incal la,v mgutlling eonslmclion <br /> Thal� m;mlho��zeJ by Ihc uvum�of mP;piopetly to pedoim i�c vmik lur w�mh apphcnlion r,mntic antl I rnmp:y vrilh ihe Slale CoMmclors I.aw t0 27 I1CW anJ 796 200A'NAC <br /> � _��4� S 2 8 . lS <br /> ----- ---- -- - -= - <br /> wn+r AW Iwrized Ayent Signalurc U.�l� (He�n;cJ��iZD15) <br /> 1/ � <br /> � �i <br />