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DEC/16/2015/WED 09:58 AM <br />Greenv�ood Heating <br />� <br />PEF�MIT <br />FAX No,206 462 6216 <br />� <br />�PPLIC,ATION <br />P, 001/003 <br />�UILb�NC/MECHANMCA!_./PLUMBINC/S1GN/SPRINKLER/DEMOLITION <br />CIiY OF EVERETT PERMIT S�RVICES <br />3200 Cedar 5t_, Everett, WA 98201 425-257-8810 �AX 425-257-8857 www.everettwa.org <br />APPLICATIONS AR� ACC�PT�D FaOM 8 AM TO 4 PM <br />SITE AE7DRE5S• PIiOPERTY TAX # P�I�M`T� �.-� �� r—• <br />V� 04� �02L1�Cb'T�..c�'� f l� 1 I ��`"� <br />LEGAL for n�w construciion: Short Plat/subdiviaion Lot No. (attach copy of lonc� lega[ �3sscrip4fan) <br />��✓N�Fi � 1� j" Phons/E-mall t -- � � <br />Addross L�� 1 � � � � Ciry/STats/Zip ��Q,lfe �� q <br />APPLICp.NT: _ Qwner ,� Owner's Agent GOntr�G[O� _ C011tfaCtOf�S AfleTlt � TO�Hnt (must proNds a ietter oPconeanttrom thb ovmerto do rrork in eha spaasl <br />CONTRACTOfi <br />BUILDING PERMIT APPLICATION <br />L&ILic.#L'� tt� J-� " <br />Pttone/Email � <br />CONTACT FOi� PERMIT <br />C-���vx�oc� t�ec�- <br />Pnone�E,ma�� CZCXDi �S <br />CONTRACT PRICE QF WORK <br />Existing Use of guilding � <br />Proposed Use of Buflding <br />6uifding typ6� 5ingle Family _ puplex _Townhouse _ Mu[ti-Family _ Commercial <br />Type of project: NQw Addition ReliZodei Re 81Y "I".I. Sign S rin{der . <br />D�SCi�IPT]ON O WORK (edditiona! space provided on the back) : <br />���4c� l t�c r�� zo v� e�.u�-� le� he.�+ -� pu tn� <br />N+i�bi�i �l�z..C�E2�i1v�1 � <br />ENIECHANICAL PERMlT APPLICATION <br />Typa of ProJeot: _Now �Adcin ,�3tere <br />� Sl�ow Numbor (!�) of flydvres <br />A/C — air handlin <br />� Forced air sysfar <br />Cas pipinq <br />Water heater <br />Gas fire lace <br />Gas ranqe <br />Clothss dr @� <br />Ran e hood <br />Exhaustfan <br />Heat um <br />U�it heater <br />gailer <br />3TngeratlOn <br />oodstove <br />_Repair <br />units <br />s <br />� Other <br />SPR�NKLER / SUPPRESSION SYSTEM <br />Number of Heads <br />'_LV 1 CO� Bus. Lic. �f(, <br />o� ��Sy - [ �t I �C <br />t� �A� <br />�f -�S ��C <br />�� <br />HEAT SOURCE: <br />Electric Other <br />o � <br />�iotition Cl�en�e of Use <br />PLUI{lIBING �ERMIT APPLICATION <br />of Projeot: _New _Addn �Aftarat;on �Repair <br />Shaw Number (#) ol' Mxturas <br />j Toilet <br />{ gathtub <br />Lavstory (wash 6asin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Cfothes washer <br />Water heafE3r <br />Sink (service/bar/mop/E <br />gackflow prsventer <br />Urinal �� <br />Drinkinq FpUntain <br />Floor drain <br />Ctirease trap <br />Roof drains <br />Nledical Gas <br />Other: <br />�fher: <br />I ttsrsby calirfy that I h�ve read and examined this applicetion and know the aame to be trua and correct. All provlslons of laws antl ortlinencss govsrning this type of work will be COmpiled <br />with whether specified hereire or not. The grenting of y permh doe5 nOt p�3Urng t0 gNe aUlhOrtry to vlofatg Or cancel tfie prov�slan of any other state or local law regulating constructf0� <br />Thet I em autharizsd by the ownar of thls praperty tp perforni th� worK foC WY11Ci1 ap�IlCatiort ig mdtls antl 1 comply With the State Contractors Law 18.27 RCW and 296.200A WAC. <br />_ `L, <br />Owner/ uthorized Agent Signatufe Date (ReviSed 6/'2012) <br />