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Lo�—( l <br />-r�`" f i(�o ( lk� t�v <br />PERMIT APPLICATION <br />BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 wv✓w� verziN�a.org <br />ADDRESS: <br />�� o <br />tor new canslmc�ion-. Short <br />� <br />R-oOnl N• /!f( Kaf�� <br />10� �i Fw � <br />TAX k <br />No <br />PERMI # <br />GI 02' <br />(altach eopy of long Icgal descripuon) <br />�i��77 �v I <br />�c_eil` �.�,'a ,r ��ic <br />PPLICANT:_Owner _Owner'sA9ent _Contractor _Camracior'sFgenl _7enan!��o:ic�n,eo,�i��ro�oi��;emvc�oNao.�e�ueo.ca�.,u,o.v�:�� <br />nuraerrna �)/ll�i i� il A V� f�TF��% Stale Lie. # l�G I K��=7 P��uWt1Y 8us. Llc. # <br />J <br />PhonelEma�l �F"�+� �J �— <br />BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br />Existing Use ot Bwltling _ �!^ HFAT SOURCE <br />Proposed Us= of �uilding � f �_ Gas_ Etectric_ <br />Bwlding type: � Single Family _ Duplex _Townhouse _ Multi-Family _ Commercial <br />Type of project � New Addition _ Remodel __ Repair _ T.I. _ Slgn _Sprinkler _Oemoli�ion__Chang <br />DESCRIPTIO OF WORK(add�t�w�alspaceprov�dedr.irn3�ace)�. <br />�� �te�rr�o� f3 I3asic #5�� <br />MECHANICAL PERMIT APPLICATION <br />ol Projoct: �Nevr _Addn _Alteratlon _Repair <br />Show NumbeNd) o! /ix(urc5 <br />� A/C — air handling un�ls <br />I Forced air svs�ems <br />RI <br />Wa�er <br />dryf <br />hood <br />NumberotHeads <br />ON SYSTEM <br />� <br />PLUMBING PE3iMIT APPLICATlON <br />TypoofProJocC New_Addn _Alteration_Ropair <br />Show Numbcr (N) ol lixtuies <br />� Toilet <br />Z 6athtub <br />— Lavatory (wash basin) <br />j Shower <br />� Kitchen sink 8 disposal <br />� Dishv+asher <br />Clothes washer <br />Waler hea�er <br />Sink (service/badmapletc ) <br />� Backflo�v preventcr <br />� Urinal <br />I Drinkina PouNam <br />Rool drains <br />Medical Gas <br />Olher <br />Othzr <br />inerebycerbtyina�Ihavereatlan4e.am�nedthi:app5wtionanCVnowlhesomelobelmeandcorma PilprevissnscllaasandcrCinancesgovemingl�.rslypeolworkwllGeromphed <br />w:t� wnemer specGetl nerein or nol T�o g�anhng al a DertnA ocrs not prewme to 9rve au'norny;o vmla!e or cancel Ine pmvis�on oi any oi��er slata or loral law reowating ccnsvvqion <br />Thct I am oulnerixetl 0y I�e orv�er ol l�is F�op^� etlortn t�e v�oik far wnic� aFG'������on k mo^e an� I eemply n�ID the Slafe Conlraclors la.v 18 27 RC W an0 296 200H lV%�C. <br />�,�y ��� <br />O ner/A lhorizedAgonlSignaWro �a�e . (Revised3l1013) <br />