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P ERN n rAPPUCATI®N <br /> BUIL.DING1MECHANICALIPLUMBING/SIGNISPRINKLERIDE l OLITIOM <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett,WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br /> PROPERTYTAX# PERMIT# <br /> sITEAZOQ4- <br /> 'np Lot No. (attach copy of long legal descrlption) <br /> LEGAL for new constNction: Short PlaUsubdivision� f`� _ - - <br /> OWNER �[fC �C�`"1� • 1 1 PhonelE-mall <br /> ��� �,,,�—U� �llva��f141012 <br /> City/State/Zip <br /> Address <br /> ersAg!_ent Contractor _— <br /> ContractorsAgent ._Tenant(must provideatederofconsent from the oanertodobwrkinthe space) <br /> APPLICANT:_Obmer _O�m <br /> CorlrRAcroR) it (/l> IGII��%/I� JIB-? r,6) StateLIc.# L`7Ji, ,+V +��1�7�� CltyBus.Lic.# • . <br /> (G `SLI fr �UYt4 )i�, I PhcnelEmall <br /> Address C INTACT OR PERMIT <br /> TENANT B SINESS NAME <br /> Phone/&m-ailLr� ©i(5 �� <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> HEAT SOURCE: <br /> Existing Use of Building <br /> Gas Electric Oilier <br /> Proposed Use of Building <br /> Building type: _Single Family _Duplex Townhouse =MUKI-Family _ Commercial <br /> Type of ro ect: New Addition Remodel Re air T.l. Si n S rinkler Demolition Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> 5ul e <br /> T APPLICATION <br /> MECHANICAL PERMIT APPLICATION <br /> PLUMBING PERMIT <br /> Typo of Project: __Ngi <br /> Alteration_Repalr Type of Project: _New,Addn _Alteration._Repair <br /> Show Number(# of fixtures <br /> Showixfures TA <br /> ilet <br /> handling unitsb <br /> s stems wash basin) <br /> r <br /> Water heater n sink&disposal <br /> Gas fire lace asher <br /> Gas ran a s washer <br /> Clothes d er heater <br /> Ran a hood setvicelbarlmo lett.) <br /> Exhaust fan ow reventer <br /> Heat um Unit healer n Fountain <br /> Boller Floor drain <br /> Refrl eratlon MMedical <br /> Woodstove s <br /> Duclin asOther_SjPRINKLER I SUPPRESSION SYSTEM Number of F{cads <br /> I hereby certify itiat l have read and examined this appilcation and knovi Ube same to be true and correct.All provistons of laws and ordinances governing this type of workwal be comp <br /> Witt whether specified herein or not.The granting of a permit does not presume to give authority to vallate or cancel the provision of any other state or local taw regulating eonsbucdon <br /> 4Mmauthorize by the ow of thisgrope ty to perform the work for which application is made and I comply Wth the Stale Contractors Law 18.27 RCW and 286"200AWAC. <br /> (Revfsed9/20f9) <br /> horize Agent SlUnAturo <br /> Date ��� - <br />