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425-252-1666 CM HEATING 01;35:45 p.m. 05-13-2015 2/3 <br />�RMfT APPLICATION� <br />BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLfTION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8657 www.everettwa.org <br />SfTE ADDRESS:�'/D ��„ _ L_ Or� PROPERTYTNCH p R �� r w , <br />`T ��r'�' �-� <br />LEGAL for new oonstructian: 5hort PfaVsu6dlvislon LqCNo. {attach copy of long legal descriplion) <br />� • <br />OWNER �j� PhanQ/E-ma11 �j7. 5 % 2 Qrp�p <br />Address 3�� (l�Q��O`/'� Clty/51a�e/Zip �- g8 2D� <br />APf'LICANT:`Owner _OwnersAgent �Contractor _Conlrectar'sAgent Tenant(muatprovideeiauerorconaemeom�,eom,ermdowori�mu,n.pac�� <br />� y�� <br />CONTRACTOR a, ( � L State Lic. �7r��� - Cfty 8us. Lic. #0`�Qd <br />Address Y`� �'Q.r�'� ��-1 g�r Phone/Email _�'� Z�q UlUJ� <br />TENANT BUSINESS NAME CONTACT FOR PERMIT `: - <br />. ,� t�b�;e� �25.Z5q �►a�(o. <br />. . P one/E-mali ,: . �{� <br />BU1 _ , . ,.;., , ,_ , <br />�LDING PERMIT APPLICATION coNrRAcr.PRlce oFwoRx ;� gg-0 � <br />. <br />Existing Use of Building HEAI' SOl1RCE: <br />Proposed Use of Building Gas . Electric Other <br />Building type: _ Single Family _ Duplex .`Townhouse _ Multi-Family _ Commercial <br />T e oF ro'ect: New. Addition Remodel Re air 7:1. Si n S rinkler aemoliticin . Chan e of Use <br />DE$CRiPTION OF WORK (additional epace provided on the tiackJ: <br />� <br />MECHANICAL PERMlT APPLICATION ` PLUMBING PERMIT APPLICATION <br />Type af ProJoch -_Now _qddn _Alteration _Rnpait Typo of Prof oct: ^Nnw Addn _Aftarxtion Ropalr <br />ShowNumbar t►) o/rrtures ShowNumher i� off7xtures <br />A/C .= air handlin units 7oilet <br />Forced air s stems - Bathfub <br />Gas 1 fn Lavato wash basin <br />WateP heater Shower <br />Gas fire' lace Kitchen sink & dis osal <br />Gas ran e Dishwasher <br />Clothes d er Clothes washer <br />Ran e ho6d Water heater <br />Exhaust fan 5(nk service/barlmo /etc. <br />Heat' um Beckflow ereventer <br />Boiler unnai <br />., _ . . .. _ Dnnkinn Foun <br />Floor d�ain <br />Woodstove Grease tra <br />Ductin Roof drafns <br />Other Medica! Gas <br />; SPR[NKLER / SUPPRESSlON SYSTEM. O�her: <br />Number of Heads . Other. <br />1 herehy cerlity that I have raad and axamined thls appllcaUon and Jcnow fhe sama lo be true and carrect, A!I Provisions of laws and ortfinancesgovemin8 ihis typa of worlc vd0 be camp! <br />with whethnr epedfied herein ar noL Tha grantlng oi a Parmit dooe noTprasuma ta give autharifylo vtalale nr cancei lha provislon ol any othei stale or lacal law regulaUng canstrucilon <br />That I am euthorizad by tha owner of ihJa proparty !o partorm tha work for whfch appGcation Is made aqd I comply wilh tha &tale Conlrectore Law 18.27 RCW and 2�36.2DOA WAC. <br />. <br />Ownar uthorizod'Agont gnatu�e ' � r �'�� <br />Date (Revlsed 92014) <br />