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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 - www.everettwa.org <br />rcnvcn cone A AM Tn A PM (-/ a.- .D 3 "1 Z <br />Ar'FUCA i-,"S—PQ <br />ITE ADDRESS: <br />�y Z 7 3 i' it'd <br />PR TAX <br />j'/�ry 2CCco 7Dr' <br />LEGAL for new consimcbon Short PIaVSUbdwision (,x%/ZAJcf- If;I F/P/`_ _Lot No _/3_ (alldch cODY 0f long legal descnp00n) <br />OWNER eA IfE44iifr. Ctrr'J-✓--r- <br />phone Emad 10 -'3/74--;I[ <br />n <br />City/Slate/Lp K,Vr4q 7{ r,'tIA <br />Address 3G ?- -11 (� y✓" <br />CONTRACTOR ` N?ANCF. IrN/ lGb$ L 81 LIC. # NCI f= S C�' u " <br />Address NI—NEi ^' /r1nll✓ sT' F�'f�„ WA A f'o1/ Phone Email yU-N(1-14,1. <br />TENANT BSS NAME <br />CONTACT FOR PERMIT` <br />( �// <br />I.>:e , q17 '73,����r <br />I'lior.E Mail0/Ali <br />BUILDING PERMIT APPLICATION <br />CONTRACT PRICE OF WORK <br />Existing Use of Building L- �H//EAT SOURCE: <br />79 ;<- Other <br />Proposed Use of 9ullding _ _ _ _ Gas Electric <br />Building type: J65ingle Family _ Duplex _Townhouse _ Multi -Family _ Commercial <br />Typo of project: _ New _ Addition _ Remodel _ Repair �.T.I. _ Sign _Sprinkler Demolition Change of Use <br />Description of Work (additional space provided on the back): 1A1fA1uV[A AIF-W 40t/Clr4�4r AI All 'T 117 - �( <br />NO <br />Have you started working without a permit? _YES✓` <br />MECHANIC aL PERMIT APPLICATION <br />PLUMBING PERMIT APPLICATION <br />Typo of Project New - _Addn -_Alteration Repair <br />Type of Project: _New _Addn _Alteration _Repair <br />Show Number a of fixtures <br />Show Number # of fixtures <br />A/C - air handling units <br />Toilet <br />Forced airs stems <br />Bathtub <br />Eavatcry fwash basin <br />Gas piping <br />Water heater <br />Shower <br />Gas fireplace <br />Kitchen sink 8 dis3osal <br />Gas ra a <br />Dishwasher <br />Clothes d at <br />Clothes washer <br />Ran a rood <br />Water healer <br />Exhaust tan <br />Sink service/barlmo etc. <br />um <br />EIt <br />Backflow eventer <br />MHeat <br />heater <br />Urinal <br />Drinking Fountain <br />Boiler <br />Floor drain <br />Refrigeration <br />Grease ba <br />Woodslove <br />of Rodrains <br />Ducll <br />Other <br />Medical Gas <br />SPRINKLER I SUPPRESSION SYSTEM <br />Other: <br />Number of Heads <br />Other. <br />I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing <br />this type of work wtl be complied wth whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel <br />the provlsi of a y olher slate or local law regulating construction or the performance of construction. That I am authorized by the owner of this properly <br />to pedor e k for winch applmal on la made and I comply wild the 318te Contractors Law 18.27 RCW and 296.200 WAC <br />Own 1 ulho atl Agent Signature Date (Revised ?/201t) <br />