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P�IAR/Z1/1017/TUE 0�; �7 APVI hJort� �`ree[c Aoof in,� FAX No, 425 4�� �524 P, 002 <br /> PERMIT APPLICATION <br /> BU��,DING/MECHAN�CAUPLUMBfNG/SIGN/SPRINKL�R/DEMOL,�TION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-�857 www.everettwa.org <br /> APPL.ICqTIONS AR�ACCEP7ED FRQM 8 A!N 1'O 4 PM <br /> SITE ADDR�SS����� � PRQPERTY TAX# P I # � <br /> LEGAL for new constructlon: Short PfaUsubdivlslon Lot No. (attach copy of lony legal descriptlon) <br /> OWN�R �� � '�,�(, Phane/�-msil �1. W�'— � S <br /> Addr�ss �� �'�� Cliy/State/Zlp �� � (� <br /> ApPLICANT:_Ov,mer _Owner's ligent �Contractor _Contractor`s A�ent _Tenant emuet o��iue a ie�a,r ofconaentkorn Bie ovrnerio dov.rork in the eoecoj <br /> CONTRACTO �(� �..tj p L�I �Ic.# O� 1 �� ��� CO�Sus.l.la#O <br /> Addross O �\ ' ��l(� ��� O Phone/Emafl ��—'� <br /> TEfVANT BUSINESS NAM� GONTACT FOR PERMIT <br /> �.4�-er��g, <br /> Phone/E-mail �"��3 '" <br /> BUILDING PERMIT APP�.ICATION CON7I�ACT PR[CE O�WORK O ��i� - 6`� <br /> �xisting Use of Building H�AT SDURGE: <br /> Pra�osed Use of Building __ __ Gaa Eleckric Othar <br /> Building type: �Singla Family �Duplsx✓Townhouse _Mufti-Family _Camm�rcial <br /> T a at ro eck: Naw Addition emaciel Ropalr T.I. SI n S rinkler Dsmolition Chan e af Use <br /> D�$CFZaP710N OF W0�2F�(additlone!speca provided on fhe beck): � <br /> `��2.�(' 6-� ��� '�DO�t� �,I��C�9.S�. VV�-�� �'�' `i� ��` � <br /> IVI�CH�►NICAL PERMIT APPLlCATION PLUMBING PERMIT APPLI�qTION <br /> Type of Project _New_Addn _Alteration_Repair Type of Project: _New_Addn �)teration_Repa3r . <br /> Show Number # of flztures Show Number # of flxtures <br /> AIC—air handlinc�unifs Toilet <br /> Forced air systsms Bathtub <br /> Gas 1 inq Lavato wash basln <br /> Water heater Shower <br /> Gas fireplace Kitchen sinEc&dis osal <br /> Gas ran e Dfshwasher <br /> Clothea dryer Clothes washer <br /> Range hood Water heater <br /> Exhaust fan Slnk seNlce/bar/mo /efC. <br /> Heat ump Backflow preventer <br /> Unit heater Urinef <br /> Sailar Dr]nldnq Fountaln <br /> Refri eration Floor drain <br /> Woodstove Grsas�frap <br /> Ductlnq Root dralns <br /> Other Medical Gas <br /> 3PRIN�C��R / SUPP��SSI�N SY'ST�IV� Other <br /> Number of Heads Other: <br /> I hsr6by ccrtify that I h�ve re�d antl axsminetl this applicstion antl know the s�me to be V�e sntl correcL All pro�islons of Isws anH ordin�ncr governing fhi��pe of wori�will bs compfi6d <br /> wRh w�ether apeclAed herafn or not.Tha granting of a Dermit does not vreaume to gN6 authority io violate or cancel the vroviaion of eny other atete oNocal law regutadng coneVuctlon <br /> That I am authorized bY thF owner of thls pr�roper4y lcv peHprm the work forwhSch�pp)IGaf�vn Is rnadc and I comply with Ihe Sla�e Cocat�atolors L�w 18,27 RC'/�/and 29e.200A WAC. <br /> C�3�� j� !� <br /> ner/Author�zed Agant Signature Date (Aevised 6/2092) <br />