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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 wlnnv.everettw .o_rg <br /> SITE ADp RESS: 1 `_ ' , I PROPERTY TAX N PERMIT 11, <br /> \'Z : S.t d— e� <br /> LEGAL for new construction: Short Plallsubi ivision__ Lol No_ (allach copy of long legal desuipllon) <br /> OWNER �h�fLl..S S'�I�t'O V �'� Phone/17-mad <br /> Address li— :040 CA S'�— S L"J Cily/Slatelzip -ia zzJ 'J'I <br /> APPLICANT:—Owner _Owner's Agent _Contractor _Conlrocloi's Agent _Tenant lmnl porMe nienerWcanfenl lrom iM onrtr ludowoo'Mlea rpraq <br /> I�V <br /> CONTRACTOR f� State Llc.N I R ar C 0 I�,.�, N F �C-iflyrBus <br /> Lic.N ♦/5Q31 <br /> AddresseCT1Oto A 0Ad " w W16144 Phone/Email 'T 4 j T T-�'Z3 Tr,J <br /> TENANT BUSINESS NAME \ CONTACT FOR <br /> �PERMIT �A <br /> Phone E mail' <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> f=xisling Use of Bwldmg__ <br /> HEAT SOURCE: <br /> Proposed Use of Building _ ___ ___ __ . Gas Electric Other <br /> Budding type: _Single Family _Duplex_Townhouse _Multi-Family _Commercial <br /> Type of project. New Addillon Remodel Re air T.1, Sign._Sprinkler_ Demoblion Change of Use <br /> DESCRIPTION OF WORK(additional space prowded on the back <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Typo of Project. _New_Addn !Aunrahr r,_ Rrp.,,, Typo of Project: _Now_Addn _Alteration_Repair <br /> Show Number N offixtures Show Number(A)of fixtures <br /> NC— <br /> alrhandlin initis Toilet <br /> Forced airs stems Bathtub <br /> _ Gas piping Lavatory(wash basin <br /> —' Water heated r— Shower <br /> Gas fireplace Kitchen sink&disposal <br /> Gas rangy_ Dishwasher <br /> Clothes dryer Clothes washer <br /> Range hood Water healer <br /> Exhaust fan Sink(servicelbar/mo /ale) <br /> Heal um Backflow preventet <br /> Unit healer Urinal <br /> Boiler Drinkin Fountain <br /> Refrigeration _ Floor drain <br /> Woodsluve _ Grease Ira <br /> Ducting Roof drains <br /> Other Medical Gas <br /> SPRINKLER 7—S UPPRESSION SYSTEM Other <br /> Number of Heads Other. <br /> Inoreby cenAy that l hovnread and ceamined this <dime end ow The same lobe iwt and correcl,An provisbnsol lows and ordnancesgovemmg Tho type of wad will be wmp4ed <br /> win whether speuned hmwn or na pwim 0.eLt s not presume to give outhonry to vlolale or cancel aw provision of any other stale or local law eguinhng eons <br /> tmd'^n <br /> That l am ernhdnre owner of mh p erly to pr The war appticatiw Is made ami l comply WIA the elate Contractors Lew U gr RCW and 296 200A WAC. <br /> " <br /> welerlAulhotieed A I Signature Date (Revised J/T01J) <br />