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PERMIT APPLICATION <br />BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES ti13o112' <br />3200 Cedar St., Everett, WA 08201 - 425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />•rrcoTFn FROM A AM Tfa A PM <br />zsFFLiCArw,..+..... ....__. .__ <br />FROM <br />_ <br />SITEADDR G M V PROPERTY TAis R IB <br />Y G✓r'✓e <br />LEGAL for new construction: Short Plaat/t/subdivislon _ l.ol l' / (attach copy of long legal description) <br />OWNER H.9/ lq !(.(" Z Phone/E-mad ryv a6 /19 �/ .t�� nj-e7 _ <br />Address ,(3gIL! ✓G G✓! Y! r i✓ 9�� C:Iy/Slate/lip I� YC YK <br />CONTRACTOR N -1 4 ✓ L 81 Lic. A <br />Address 5 Ciro G. Phone/Email <br />TENANT BUSINESS NAME +Ph�ne/E-mail <br />ACT FOR PERMIT <br />giBUILDING PERMIT APPLICATION RACT PRIG OF WORK <br />HEAT SOURCE: <br />Existing Use of Building <br />Proposed Use of Building Gas Elecidc Other <br />Building type: __ Single Family _ Duplex _Townhouse _ Multi -Family _Commercial <br />Type of project _ New _Addition _ Remodel _ Repair _ T.I. _ Sign _Sprinkler _Demolition_Change of Use <br />Desct0tion of Work (additional space provided on (he back) : <br />Have you started working without a permll9 _YES _NO <br />MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br />Ty po of Project: _Now_Addn _Alteration_ Repair Typeer Pro)ecl: _Naw_Addn _Alteration _Repair <br />w Number (a/ of fixtures Number (0) of fixtures <br />Sho <br />A1C - air handling units Toilet <br />Forced airs stems Bathtub <br />Gas piping Levato wash basin <br />Water heater Shower <br />Gas fireplace Kitchen sink 8 disposal <br />Gas ran a Dishwasher <br />Clothes drys( Clothes washer <br />Ran n hood <br />g,7�2Water healer <br />Exhaustan Sink service/bar/mo /etc. <br />Heat r Backllow reventer <br />Unit heater Urinal <br />Boller Drinkinq Fountain <br />Refri eration Floor drain <br />Woodstcve Grease Ira <br />Ductingof <br />drains <br />-' OtherMedical Gas <br />_-_ <br />SPRINKLER / SUPPRESSION SYSTEM other: <br />Number of Heads Other: <br />1 hereby certify that I have read and examined this application and knew the same to be true and correct. All provisions of laws and ordinances governing <br />this type of wort will be complied win whether specified herein or not. R It granting of a permit does not presume to give aulhoilly to violate or camel <br />the provision of any other state or local law regulating construction or the performance of construction. That I am authorized by the owner of this pro xerty <br />to perform the work fe- which application is In a and I comply with t a State / nttrractors Lew 1e.27 RCW and 299.200 WAG <br />I (Revised 21201 f) <br />OwneCAuthoriza go Slgnatur Dale <br />1 hereby certify that I have read and examined this application and knew the same to be true and correct. All provisions of laws and ordinances governing <br />this type of wort will be complied win whether specified herein or not. R It granting of a permit does not presume to give aulhoilly to violate or camel <br />the provision of any other state or local law regulating construction or the performance of construction. That I am authorized by the owner of this pro xerty <br />to perform the work fe- which application is In a and I comply with t a State / nttrractors Lew 1e.27 RCW and 299.200 WAG <br />I (Revised 21201 f) <br />OwneCAuthoriza go Slgnatur Dale <br />