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425-252-1666 CM HEATING 02:21 58 p.m. OS 18 2015 2/4 <br />__--------------- .----_.__.__.__.__.�_- <br />�_ ------- - ------�--�--------- ------- _ ______ . -__.__. <br />P�ERMIT APPLICATtON <br />BUILDING/MECHANICAL/PLUMB�NGIS�GN/SPRfNKLER/DEMOLtTION <br />CITY OF EVERETT PERMIT SERViCES <br />3200 Cedar St., Everett; WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br />51TE ADDRESS:�� �� C E PHOPERTY TAX i! PERMIT S O <br />c7 � <br />LEGAL for new constnt�ildn: 5hort PlaUsu6dfvlsion Lql Na. (attach eopy of Iong legal dascr(pQon) <br />OWNER ��'is �' Phone/E-mafl _ <br />Address 5 � �r � C(ty/Staie/Zlp �� 9a ��� <br />APPLICANT: O�me� _OWner'sAgenl �Conlractor CotttraciorcAgnnl Tonant�mu�lp�ovWealoaerotconeenttromu,eovmer�odovrorx�,u,n,pacoy <br />.: � , �� 5d 1 h <br />CONTRACTOR Q, � L State Lic. f1 Cit Bus. Li�. # �{� v. <br />, <br />, <br />Address r'� �•Q,�� ��'i q g�Q� Phone%Emall .�� 259 `„QLY� <br />S NAME ' CONTACT FOR,PERMIT : ' <br />TENANT BUSINES � i��� 2� r Jb��* <br />-� �Y <br />, ,; : . <br />P��e/E-ma1l . � . �i� <br />_ . :' . „_, . ; . .., . <br />BUILDING PERMIT APPLICATION CONTRACTPRicE oF WORK .�'rJSS .OU <br />Existing Use of 6uilding HEAT SOURCE: <br />Proposetl Use of Building Gas Eleciria . other <br />Build'tng type: _, Single Family T, Duplex _Townhouse Multi-Fatiiily _., Commercial <br />T e of ra ect: New .: Addition Remodel Re air 'T':I. 5i n,.. S rinkier Derriolition . Chan e of Use <br />_ k` <br />P. P <br />DESCRIPTION OF V1�ORK (addltlonal s ace iovlded on the 6ac j <br />�n5-�u. 6 � h.�,�?.vn-t,� , <br />_ _ _ __ <br />'MECHANICAL PERMIT APPL�CATION PLUMBING'PERMIT APPLICATiON <br />Typn of PcoJocL _Ndw `Addn `AltQration _RopaTr 7ypa of Projoct: �Naw _Addn _Alteratlon _Repair <br />Sho� Number i! af f/xfu�Qs' Shaw Numher fi af flxtures <br />A/C = sit.handlin units Tollet <br />. Forced air s stems ` ' Bethtu6 `' � <br />Gas i 1n , Lavato wash basin <br />_ Water fieater ` Shower _ <br />Gas fire' lace Kitchen sink & dIs osal <br />Gas ran e DishWashe� <br />Clothes d er Clothes washer <br />Ran e hood ',Water heater <br />Extiausffan Sink' service/bar/mo /efc: <br />Heat ilm Backflow 7eventer . <br />Unit heater Urinai <br />Boiler Drinkin Fauntain <br />Refri e(ation Floor drain . <br />Weodstove Grease.tra <br />Ouctin Roof drains <br />Other Ntedical Gas <br />,:... <br />" SPRINKLER'/ SUPPRESSI ON_ SYSTEM ' 0ther. <br />, .. . : . , . _ . <br />Numbe� �f Neads 04her_ <br />1 heraby ce�tity �het I hayo read and examinad lhls eppllcalton and knvw lhe same to 6a lrue and carract, Alt prcvlslon� of laws end ordinances Ovyeming thls typa ctvrark wtll ho compi <br />with whuiher spacified herein or hot. The grantlnp dt s parmlt doeS not ptesume to pfva sutharfty lo viafale or cancei tha pitivision of any othar stale or local law repulaHng constructian <br />That I arn aulhor{zed hy lh.e owner of th[s propeAy lo pejform tha tirork far Wfiich appfcslion fs mada and I camply wilh the Slate Canlracio�e Law 19.27 RCW and 298200A WAC, <br />` <br />� 5-18 •I5 <br />Owner uthorizad Agont gnalure ' Oate (Ravlsed 920i4) <br />