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Ca11 �o� c,c,. �a �- p�ease� ,�n��.l bac.k. a,�p2o� E.D <br /> 3 (e0- le l 3 -qSS o � � �er'w��� 1- . T- <br /> " nQn �" PERMIT APPLICATION p (���� <br /> BUILDING/MECHANICALIPLUMBING/SIGN/SPRINK�E LIT14�J � <br /> �IJQ J I L.,, <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 58201 425-257-8810 FAX 425-257-8857 wv�n twa ory. '` . .J <br /> �'��1� �a3:�a c <br /> SITE ADDRESS: PROPERN TA%p PFRMIT# <br /> / E�e ree� Lt� a. aBo4 ooaooioo 0 5 � <br /> LEGAL for new conslrucUon Snort FiaVsu6tlivis�on Lot No. Iattach r.opy ol lonq legal descriplion) <br /> OWNER�p�,�,7}� � � y�� n [p QL C Phone�E-maii <br /> � <br /> Address � �I I 1 0� � Cili/Stale2ip L' � i L �j <br /> APPUCANT:_Owner _O.vnersAaent _Contrano� �COO1�dCI0f'SAaCM _TCn,Aftl�rr,,:Ipro+�Ceac�c�o'�'soscr.i�mmi�conrcrioaowch.�nmes^.am; <br /> CONTRACTOR Sta[e L�a # � City Bus. Lic # ,�� oY <br /> address �.b . 1� o� 'S� � eV"��P �� 83g3 Gonn� a • `"'�r�_ lol —ASS C� <br /> 9 Phone/Email <br /> TENANT BUSINESS NAME CONTACT FOR PERMITGO�N� � Y� 'e-✓ <br /> I�h�,`.r�-�2 V�o,� kW Cor��', e. mo.,`u,er�wct�ecu.�e. c.o%�, <br /> �a ✓ Pho�e�E.ma� 3t�o - � 3 - R SS� <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK // 00 <br /> Existing Use of Buildmg 2. HEAT SOURCE-. <br /> r ' <br /> Proposed Use of Buildmg _ Gas EieCric Olher <br /> Bwlding type _Single Pamily _Duplex_Townhouse _Mulh-Family k Commercial <br /> T e of pro ecY New Adddion Remodel Re air TJ Si n S rinkler Demolition Chan e of Use <br /> DESCRIPTIONOFWORK (add�tiona�spacapro��dedontheDackl. �=-�� q. '� y�S��,11 ,�e�..� �ha��ne�l le� eY� <br /> p So�-�i-11 �,�Jc�..11 � I �S�0.� 1 eX\ S� iY� <br /> vJes-1 � ,1or-k� w e �-F (� , � Cl�ahv��l e'�ec-S + o <br /> I� vO�-�-� O�v � • �Ie.�OCr�� � rcJ �k � 5-� �V�G <br /> �r�o �^� v��e�- S�o re . �1 <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> 7ype of Project: _New_Addn _Alteralion_Repair T/pe ol Pro�ect: _Nuw_Addn Alleration_Repair <br /> Show Number N o//ixrores Show Number It ollisfures <br /> A/C—airhandiin untls Toilel <br /> Foru�d air s stems Bathtub <br /> Gas piping Lavalo Kash basin <br /> Water heater Shower <br /> Gas fire lace _ Kitdien sink 8 dis osal <br /> Gasran e Dishwasher <br /> Clothes d er Clothes washer <br /> Ran e hood Water heater <br /> [xhaust fan Sink sernce/badmo /etc <br /> Hea� um Backflow revenler inside bld <br /> I Unit heater Unnal <br /> Boiler Drinkm Fountain <br /> � Re(ri eration Floordrain <br /> W oodstove Grease tra <br /> Ductin Roof drams <br /> Other Medical Gas <br /> SPRINKLER I SUPPRESSION SYSTEM Other. <br /> Number of Heads Other <br /> I�ereCy cetldy ihal I have reatl anG e�aminetl t�is appliGilion antl kncw Ihc same to be INe and rArten.F��pmviS�.ons ot lawi an0 ortlinaotes goveming ihis type ot q�ork M��Ce fvmp <br /> x�lh wnel�er speufie0 herem or not The granting of a Gertnn tloes ncl presume to grve authonly to violate or cancel lhe provision of any alner slale or lowl I�w re9ulaling fnns'ruct;on <br /> Ttlat I am auihonied by Ihe owner W In�s pfopeny to penorm me work lor w�mn appica4on is maCe an0 I compry wnn the State Comradcrs Law 18 27 RCW antl 296 YOON WFC <br /> �� _ �'v <br /> OwnerlAuthorizod Agont Sig ia u Da e (Rev�sed 4/2015) <br />