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PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIG NIS PRINKLER/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 /> SITE ADDRESS: paOPIRTV TAX PERMIT 0 <br /> q a•" mete-N o �k 0000 ( 00 5 <br /> LEGAL 1m new construction Short Plat/subdivision LoI Nu_ (attach co,y of long legal desa p',�n) <br /> OWNER C PhonefE•mad LA?- 5 1 <br /> Admess 3 \1 — —7q— P GtylslaleRip cveze* Will 78263 <br /> APPLICANT: _Cwnei ,Owners Agenl _t(Conlracter _ Cor.Iradors Aeent ___ Tenant •Nm nwao+u•nnco•ve-r r�Ta near vee womm�s+raael <br /> CONTRACTOR ,,, State Lic.p ALM c Hs`o4.0 City Bus.Lic 0 p o <br /> Lj <br /> Address Cir,-?-5 W yie a dr,,—) a cry-+ts 4�a Phone/L ma l 3 � •pt fo Z <br /> TENANT BUSINESS NAME [iony,IE-manl <br /> ONTACT FOR PERMIT <br /> L: S � k n 1 e.+t•y <br /> 3(00. .S Ccb - OI(z l <br /> BUILDING PERMIT APPLICATION ICONTRACT PRICE OF WORK_ _ b 31 S3 <br /> Cx sung Use of Building--- _._ __—. _—_ _— I HEAT SOURCE <br /> Proposed Use of Dailding I G&sZ Electric other <br /> Budding type _Single Family _Duplex_Townhouse _Multi-Family _Commercial <br /> 1 pe of pro ect New Adddion Remodel Repair T I Sign_Sprinkler Demolition Chane of Use <br /> DESCRIPTION OFWORK(additional space prowdedon(he back) � <br /> (1\♦C.P� +; 'k^s4-lik 130 ). -�r'T ( #Pt Chis -C+.IYN(CJ2-. <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Typo of Protect: _Now_Addn )/Alteration_Repair Typo of Project: _Now_Adan _Alteration_Repair <br /> Show Number(a)of fixtures Show Number(a)or fixtures <br /> NC -air handlinq units Toilet <br /> Forced airs stems Bathtub <br /> Gas piping avato wash bas n <br /> Water healer Shower <br /> Gas fireplace Kitchen sink&disposal <br /> Gas range Dishwasher <br /> Clothes dryer t Clotheswasher <br /> Range hood Water healer <br /> Exhaust fan Sink servicelbarlmo lett <br /> Heat um Backflow reventer <br /> Unit heater Urinal <br /> Boiler Drinking Fountain <br /> Refrigeration Floor drain <br /> Woodslove Grease trap <br /> Ducting Root drams <br /> Other Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM Other <br /> Number al Heads Other <br /> I hereby mnAy that I have read and eanminad this apphc rlon and Wow the same to to true slid Coned At pmwsons of lad and ordmanoos geeemwg Old type of work we be complied <br /> with whether speplrted herein or not The gianiwg of a porins does not Presume to give suthOiay to vVele or Ca"Oel the prorisgn of any other slate or wAl law regulating rAnelNdon <br /> That I am authored by the Owner of this Property to perform the wort,for*heli epplraton is made and I pomDN'with the State Conuadois Law le 22 RC W and 296 200A WAC <br /> 41.. k-� f ti t s <br /> .Agent Slgnaluro Date (Rewsed Yl01 J) <br /> OwnorlAulhorirad <br />