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01/05/2p16 TUE ig:a5 FAx Fa�t water xeater 1�003/004 <br />-. -.... .._..---� ---. _...._ .. . . . ..--- - �-- -- --�--..._..-- --�-�--� --._._._. . _. <br />., . <br />_. . . . . ...... . .............. . .. _ ...... . ... . .. . ... .. <br />�ERMiT APPLICA7'I c�o�� � � <br />BUILDINGIMECNANICALlPL,UIVIBING/SIGN/SPRINKLER/DEMOLITION <br />C17Y O� EVERETT PERMlT SERVICES <br />3200 CecJar St., Everett, WA 98201 425-257-8810 FAX 425�257�6857 www.everettwa.org <br />A�DRES3: <br />����"� P OPER7Y7Ax <br />- � �r���l� I I Do� <br />LEGAL for naw cOn9tructlon: Short Plat/subdlvlslon Lot No. (ottech copy of long legal dascrlpllon) <br />OWN�1� 7��'v ( � V c.��� Phone/E-maU "I ��'�j � vl ��l �j ?j�' <br />C1ly/State/zlp <br />APPLICANT: � Owner _ OWner'a Agant � Contractor � Contractor's Agent _ Tenaf7t (mual provftle e leller af �or,eent (rom Ihe owner lo ao work In tne epece) <br />CONTF2ACTOR � • � - -' �� State Lfc. # �/UW ('' Q �.Clty Bus. Llc. <br />C�• la � I 1 <br />Addross ( • ' j � �' ;. ��W�( S .�, l,�' . Phone/Emalf o�� (�'3 `'1 , rcM i`�',S �.�rv <br />TENANT BUSIN E CONTACT FOR P�RMIT f1 ✓'• <br />� � �1 K� L�G <br />Phon�/E-mail � <br />BUILDING PERM1�' APPLICA7'ION CONTRACT PRICE OF WORK <br />Exlsting Use of Building HEAT CE: <br />Proposed Use of 6 In �as El�ctrfc Otlier <br />Bullding type Singls Faml _ Duplex_Townhouse Multi-Family _ Commerclsl <br />T o of ro ect: New Addltlon Remo I Re al T.I. $i n 5 rink(er Demoli#ian Chan e of Use <br />DrSCRIPTION OF WORK (add�ttonal space prov�ded on e bac� : <br />�,�,�o �-e,�,�- la c`�_ � -e� ' c,�-�r �..� a�'�r <br />� <br />MECIiANICAL PERMIT APPLICA <br />rY�e oF ProJect: _New _Addn T�,It�ratlon <br />ShOwNumber #1 offlrtUl'e8 <br />A/C — alr handiinq uni <br />� � Forced alr svstems � <br />Wafer heate� <br />Gas flre lac� <br />s ran e <br />Clo a r er <br />Ran od <br />Ex us! f <br />at um <br />nit heater <br />Boller <br />rcerri er�tion � <br />Woodsfove <br />Ductin <br />Other <br />NKLElt / Sl1PPRESSION <br />Number of Heads <br />RIN�3 PERMIT APP6MCATION <br />o! PruJect: _Naw �Addn _Alterativn _Repalr <br />SAow Numbar # 01 flx�uraa <br />I Toilef <br />S hower <br />Kitchen sink � disp <br />Dfahwasher <br />Clothes waeher <br />Water heater <br />Sink_ (servfce/bar/m <br />Backflow preventer <br />Urinal <br />Drinkln� Fountain'� <br />�loor draln <br />Gr9aS6 tfa <br />Roof drains <br />Medlcral Gas� <br />Other; <br />Other: <br />I hereby certlfy Ihat I h�ve reatl and axamfned Ihle qppllCaUon �hd knaW Ihe eame IO be I�Uo ahd cortect, Alf provlelOn6 0l laWs and ordlnancge yovarning lhls lypa of work wIN be Gomp <br />wlth whelhar epec�f�ecf hpreln or not, The pronling pf il pBfmll doea not presumo l0 Qlve dulhorlty fo vfoleta pr �anoel lhe provlslon of any olHOr ��et� Or Iocel law regulafing conet�u0lbn <br />That I am authptlZed Oy lhe owne of thls propeny lo pertorm the work for whlC� d�pp�io�tlon i� mede and I compty WIlh the 3tate Con4�eCto�s Lsw 78,27 RCW ena 298.200A WAC. <br />� � t w <br />Owns uthorlaad ge t 91gn tura Dete <br />(Ravlsad 4/20�5) <br />