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PERMIT AP ICATION <br /> CHIT`(OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St-, Everett, WA 98201 425-257-8810 FAX 425-257-5857 wVvw.evere1tllva-Qrg <br /> SITE ADDRESS- 2 O 1 0 UZ ra,064 4 r'C J <br /> PROPERTY TAX si P # alL <br /> �. <br /> LEGAL.for new c <br /> ons <br /> tru <br /> c <br /> tion <br /> : <br /> Short PlllaUsubdiviis`ioon" J� Lot No. (attach copyof long legal dCe�sc6ption) <br /> QYE1�4 Ed /(�fp► i C c/ ! / J �Y!� . _Phone/E-mail (��i Vr,�`/C/�t� 3"� / <br /> Address CitylState/ iP CSV c/r C t 1 I��JU� 0 G�1 <br /> APPLJQA_kT-—Owner Owriaf s Agent _Conimmor —Contractors Agent _Tenant(nluet pmviue a i6mar of coni nt frdrh the ownerto dowprk in the--.Paoe) <br /> CONTRACTOR (-'10+ �State L�(yiC . i S,x GamC City P"S.ue,V V Jw� <br /> Address IF60 A i ��/+/✓t a v "° /6 9! PhonelE�Yl2ii �� �A�� � c/ <br /> A FS N4AM CeQ TtgC €��° <br /> 0A I <br /> Phone/ln-mail <br /> SUILDi)NG PERMIT A PPtLICA�,° 00H CONTRACT PR;CE OF WORK <br /> existing Use of Building HEAT SOURCE: <br /> Proposed Use of F3uilding Gee Electric n <br /> Building tjpe: _Single Family _Duplex_Towr)tiouse K4lJlti-F2rnily _Con,meroial <br /> Type of roiet t: Nauil Addition _ -- Remodel Repair T.I. Sign S rinkl®r Demolition Change of Use <br /> a— <br /> DESCRIPTION OF WORK(edc1rtbf)0fsp8ce Provided on itre bade): <br /> MECHANICAL APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _,Now p,ddn _Altercation_"Ropair Type of Project: __pew T_Acidri _Alteration_,,_Ropair <br /> Show Number(#)of fixcur¢S Show Number of fixtures <br /> A/C—air handling units Toilet <br /> Forced airs stems Bathtub <br /> Cas 2iplrlo Lavatory wash pasin <br /> I Water heater Shower <br /> Gas fireplace I Kitchen sink&disposal <br /> Gas ran 6 ! pishwasher <br /> i Clothes d er _ Clothes washer <br /> t <br /> Range hood — - Water heater <br /> ^ —.-_-_ <br /> Cxhaust fan Sink setvicelbarlmo /etc. <br /> Meat pump Radflow preventer <br /> Unit heater r Urinal <br /> Baiter Drinking Fountain <br /> t Refrigeration l f=loor drain <br /> _Woodstmte Grease trap <br /> Ductin Roof drains <br /> Other l Medical Gas <br /> SPR#N9CL,ER I SUPPIRIESSNON SYSTEM i Other: <br /> I Number of News �~ Other: <br /> I hereby cert(ry chat i have read ani mamineJ 4his 2ppliration and know the same to be true and comsat.All pmvieione of law&and orainances gwarning mis type ofwork will qa compl <br /> wlkh w star 5pecihed ha din or not.Tile granting of a pemrit dnot pmwfm,to give autdontty to v ialate or cancel the ptovislon of any other state or torarl taw regalaliog construction <br /> That 1 am utharked by the 0.vrior n;ttcta p orrr top— work f0r%,1)ioiooh applicariannn is—gag and I comply with the state Contractors t.aw 98.27RCW 2nd 296.21)OA WAC. <br /> d rJ4tet orized Agent Signature Date (RetrissU W014) <br />