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PERMIT AP F
<br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMQLITION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200-Cedart., Everett WA 08201 425-257-8810 FAX 425-267-8857 Www evert twa.Or
<br /> pgQPERT(TAX
<br /> LEGAL for nee,'nnstructiont Short Platlsubdivis)on Lot No' {attach copy of)ang legal description)
<br /> OWNER Phone/E mail
<br /> lidcires r City/State/Zip
<br /> APPLICANT: Owner _,Owners Agent Contractor Contractors Agent __Tenant icsts,oars_ a lobi nt cc ont from!heavier to OP want In tha;p2}
<br /> CONrI ACTOii , A.,,,,_,,,
<br /> , 4/ .0,,,,,p '•� - State ija.# r., R -,fir City Sus,tic #e? r r7
<br /> Address I ., �, 4 .," Phone/Eritt i) ,: _
<br /> .r. It t 1 ' 1 Ca T FORRIUI .
<br /> ti5ve,
<br /> R/.:; PhonefE-Mall � • % 01)100
<br /> �Ut�»D NG PERMIT APP ICATIQ3t1 CONTRACT PRIG OF WORK f [t t 4aCS * . #
<br /> Existing Use of Building HEATSOURCE. , '
<br /> ,
<br /> Proposed Use of Btilldin t3 $i• ----„ Eteotr# 'Other_
<br /> Buliding type. Single Fatally tupie c Teweheese Multi-Family , ,, Cornri ial '
<br /> Type of:ro eat:7 New Addition Remodel Re.air T.L _ ai•n S• nkier De elition Chan.a of Ilse
<br /> DESCRIPTION OF WORK(additloeef space provided on the back) y` OV< � 'i-
<br /> MECHANICAL PERMIT APPLiGATIOl 1 si . P ".'r IT APP rC ,TION
<br /> ' Type of project. ._.,Ad l ,�4ttetation Repair
<br /> Type of Project; New__Add Alt ration , .,P j
<br /> i k ,
<br /> Sham vNutnber(#)of*yXturres ,, ' Shoat Nu €Or{t9b �Ufe$
<br /> NC- ir;handiln9.units Toil
<br /> Forced air systems S°thtuiz
<br /> Gee pipinLeua�r(wasf beslel
<br /> i''aterheater ,,Shower,,,i3aa-�irsi.�at;e
<br /> , t1tchen sinkA disposal,
<br /> Gas range Dishwasher
<br /> - Clothes dryer Clothes Washer .
<br /> Range hood Water heater
<br /> haunt fan Sinkaetvice7l}arlrrtopietc.)
<br /> Heat pump Eacictldvr/reventer(Ingidaa bldg}
<br /> Unit heyter Urinal —
<br /> Boiler Floor drainDrinking Fountain
<br /> Refrigeration
<br /> Atoodstov'e (reuse tree, . . ,
<br /> Ducting : Roof drains
<br /> OtherMedical Gas
<br /> P 1llV[ ;E .� UPPIt E~ IUB SYSTEM Other:
<br /> 1 _Number of Headsr--
<br /> ,,,, Other;
<br /> I
<br /> hereby ceJIih that I Rave read and exarhined irks app)rcattan and kilt*the tante to be hue and rorreet.Au provisions of laws and erdir€aftoea govanitig this type of rvar wiI be complied;
<br /> heryrtt jet spacIticd tterairt 4r ttat Che grenGrtg era permit loss not presume to give authority to urinate or ranee)the provision of any other slate or itr:ar,aw regulating construction
<br /> That a horfzedbytheownerof: tapo?,pt 3aperrern)theworkfarwhtchapPii•-Gen is madeend icompry iththe State Coritractors Law 9x27Rf;I+tiand 296,2i3o�sWAC,
<br /> tet° ° it."„'n ,..r _ --
<br /> e 27 J�' „ .:, .. ? (Revfsert 412015)Orator/°uthor)zed Ageen Signature Date
<br /> k Iii, a/ j �o
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