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Oct 03 1 1 03 28p Danny Klingebiel 1-636-527-6815 p.2 <br /> PERMIT APPLICATION <br /> BUILD'NG/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.0M <br /> APPLICATIONS ARE ACCEPTED FROM 8A TO 4 PM — <br /> SITE <br /> SITE ADDRESS: PRopERTY TAXA PER R <br /> SI <br /> LEGAL'or new conebudim Snort fnaUsubdivision AA(� I.d Pb_ (ana�r copy of blas legal descnmiorl <br /> OWNER / ( /SGD w\ Phweffi mei S' — — <br /> Add,esa �b ) �I•: I 9?20S S CitWStatdLp 9 <br /> CONTRACTOR <br /> L 6 I <br /> �.1 y � / <br /> Add�ess J-)/O&, /J ShrA.e^ ✓ e.7 U e p197 PnondEmaY - I L 7L G • - 1•�1 <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Pfwr:a'E•mal <br /> BUILDING PERMIT APPLICATION ICONTRACT PRICE OF WORK OVe <br /> Existing Use of Building Ii FAT SOURCE: <br /> Proposed Use of Building Gas Ekobk: _ rAher_ <br /> Buildingtype: �LSingls Family _Duplex_Townhouse _MuWFamily _Cammardal <br /> Type of project _New _Addition _Remodel _Rep9.r_T.I. _Sign_Sprinkler_Demolkian X Change or Use <br /> Description of Work faddirronar space Provded on the Deck): <br /> Have you started working without a permit? _YES k NO <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Typo of Profad: _ Now Addn XAltorsuon_Flopair Type of project _Now_Addn _Atrontion_Repair <br /> Show Number of axrures Show Number of ffrturas <br /> AIC—air handling units Toilel <br /> Forced au systems Bathtub <br /> as i m Lavatory(wash basin) <br /> Water heater Shower <br /> Gas fire lace Kitchen slnk B disposal <br /> Gas range Dishwasher <br /> _ Cldhes dryer CIOtheswashm <br /> Rance hood Water heater <br /> Exhaust(an _Sink servicelbar/mo /eta <br /> sleet pump Backflow reventer <br /> Unit heater Urinal <br /> Boiler DrlMting Founlam __ <br /> Refrigeration _ Floor drain <br /> Woodstove Grease trap <br /> Duchna Root drams <br /> Other _ Medical Gas <br /> SPRINKLER !SUPPRESSION SYSTEM Other: <br /> Number of Heads Other. <br /> 1 hereby candy that I have read and evamkwd this 81091 lren and know ere same lo be Irue and ocnecl.At p'Ovblons of taws and onerances gcvemiing <br /> this type of work vin be complied with vrtetha epacivao herexl o•not.The grrnang of a parml does not presume to give authority to violate or cancel <br /> the pwsbn of any other slate or local taw regulating nrokuc0on or fire performance of construction.Thal I en aultodied by the owner of this property <br /> to ti's�fcuM"rrrada and I orynply win the Staie C mractan lw 1a 27 RCW and las 200 WAC <br /> OwnerfAuthodxed cent Signaifm/�`\X'/J/ Dale (�vlsed?ROf 1) <br /> I I <br />