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PERMIT APPLICATION <br />BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />3230 Cedar St., Everett, WA 98201 425.257-8810 FAX 425-257-8857 www.everettwa org <br />I--a-IG/ <br />E ADDRESS: tt 3 -L S+ 'SIN <br />-5'•at <br />PAUPFRTY TAX n <br />P MI t <br />LEGAL I,, r[n c, rwutl en P aC•,.b,n: �� on I of 4u _ 'a"ar'+ rq � �:I ir.r I'�•� n 1.�s_�ipt an <br />--- - —. <br />OWNER <br />rl mnr.(- 1a4 1 <br />Add'ess <br />Gy Stale'7p <br />APPLICANT: _ (`weel's Agent _K.Contractor Contractors Agent Tenant lnwnrmwdes tee o+mmwm enm ev cwrorn de womtme wane. <br />eOwnr� <br />CONTRACTOR Jtvu-l)%%A <br />State Lic.# Ie+eh VM 171*6K City Bus Lic # <br />Phone/Emad <br />TENANT BUSINESS NAME <br />CONTACT FOR PERMIT <br />J•4. B�f0f,a7 Z-6-230 -9898 <br />PPo•e f rya I <br />BUILDING PERMIT APPLICATION <br />CONTRACT PRICE OF WORK __ <br />Lusting Use cl BwlTng _ _ _ _ _ ____ HEAT SOURCE: <br />Proposed Use of Building__ _ _. Gas Electric_ Other_ <br />Budding types _ Single Family _ Duplex _Townhouse ,j!&Multi•Farmly _ Commercial <br />Type of project New Addition Remodel Repair T.I. Sin S nnkler Demolition —Change of Use <br />DESCRIPTION OF WORK ,addnonal space provided on the back) 11 <br />W ,-A UV� <br />S <br />MECHANICAL PERMIT APPLICATION <br />PLUMBING PERMIT APPLICATION <br />Typo of Project. _Now _Addn _Alteration _Repair <br />Show Number (a) of fixturds <br />Typo of Project: _New _Addn _Alteration _Repair <br />Show Number (a) of fixtures <br />A/C - au handling units <br />Toilet <br />Forced air systems <br />Balntub <br />_ <br />Gas piping <br />Lavatory wash basin) <br />Water healer <br />Shower <br />Gas foeplace <br />Kitchen sink 8 disposal <br />_ <br />Gas range <br />Dishwasher <br />Clothes d er <br />Clothes washer <br />Ran a hood <br />Water heater <br />Exhaust tan <br />Sink (servlcelbarlmo letc ) <br />Heat pump <br />Back Row preventer <br />Unit healer <br />Urinal <br />I <br />Boiler <br />Drinking Fountain <br />Refrigeration <br />Floor drain <br />_ <br />Woodstove <br />Grease trap <br />Ducting <br />Roof drains <br />Omer <br />Medical Gas <br />SPRINKLER <br />I SUPPRESSION SYSTEM <br />l <br />Other W,Ittr \:1w.L i x1'r <br />Number of Heads <br />Other <br />I hereby canfl'that I harts reed and Summed this appkcawn and know the some to be Into end cooect An pro ,sv ns of love and enhance, govemmg ors type of work w] bo tkmpted <br />wM «names epecdtsd herein or not The groning of a permit duet nos pretumts to give autnady to viowe or cancel ets provnon of my deer state w kcal taw rogWat�ng candmdon <br />That lam aulhorded by me owner of Inn properly to perform Ina wink to which appscalkn 1t made and 1 compy won rho Stale Conbaaort Law 10 27 RC W end 291 WkC. <br />t,- 2 - "t <br />Ownert u orized Agent Signature Dale <br />(Revised 3/2013) <br />