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PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBINGISIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Fverett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM B AM TO A PM <br /> SITE ADDRESS: VNOPEqiY TAl(p i �T• _ O(� <br /> �02 E� e�.� <br /> LEGAL for new consW ction: Short Plallsubdivision Lot No._ (atlach copy of long legai Aesaiptian) <br /> OWNER Vf�d Q,� �J�j t' (:� iG �...�-�- Phone/E�mail J,O(p '�j'3�'OQ Fj 3 <br /> Address � 6'e.IleJ✓E A��Fi � c��v�s���ezv cx�4f'Ic, WA 9$lo?i <br /> APPLICANT: Owner OvmersAgent �Contrador CanlydctofsAgent Ten3n�im����.vvde+bnnarmmamxm�mev.ac�maor.onmmeswm� <br /> CONTRACTOR �.DI.{t1 �vNl � l�q� �E►J7�(v[�'iDI L81Lic.# ��k��63 q COEBus.Lic.# <br /> Address P� �Y. ��111D M� �all WA ��/D PhoneiEmail -y�c-66y� <br /> TENANT BUSINESS NAME CON7ACT FOR PERMR <br /> &b S�+k° <br /> �'C, W�1�i���M W<-h��' �1�5 PhonelE•mail +12�i' �IZ�L��y� <br /> BUILDING PERMIT APP�ICATION CONTRACT PRICE OF WORK ��� a�o <br /> Eaisting Use o(Building HEAT SOURCE� <br /> Proposed Use of Building Gas_ Electnc__ Other_ <br /> Building type� _Single Family _Duplea_Towntiouse _Multi-Family _Commercial <br /> T e of ro ecC New Addition Remodei Re air T.I. Si n S nnkler Demoli�ion Chan e of Use <br /> DESCRIPTION 6F WORK(addrtiona�space provided on(ne bacA): <br /> ZNs�N+i1 Pi,, .�,b;�.9 P�, �e� D�N�I�aI off��e_ <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type ol Prolect: _New_Addn _Altentlon_Repalr Type of Pro�e[t: _New_Addn ✓Altcratlon_Hepalr <br /> Show Numbei ol flxtures Show NumDar M of Rrture9 <br /> AIC-air handlin uni�s Toilet <br /> Forced air s slems Balhtub <br /> Gas i in Lavnto wash basin <br /> W aler healer Shower <br /> Gas fire lace 3 Kilchen sink 8 disposal <br /> Gas ran e Dishwasher <br /> Clothes d er Clothes washer <br /> Ran e hood � Waler heater <br /> E�aust fan Sink service/bar/mo letc. <br /> Heal um Backllow revenler <br /> Unit heater Unnal <br /> Boilcr Onnkin Fountain <br /> Refn eration Floor drain <br /> Woodstove Grease tra <br /> Ductin � Roof drains <br /> Other Meaical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM Other: D�Iy{'AL iR <br /> NumberolHeads 6 Olher Df/�tA� 1�A�v✓rh <br /> I hereby ceMy mat I have reaa and eiamuiea Nis aDV����on antl knvw the samu lu be We an0 mrtecl Ail pmvivons W hws an�ordmanus Boveming N's rype ol woA r.di�e wmplietl <br /> w�M wfiaUiar cpetllled�emin or not The g2nfing af a pertnit Uoes not O�e4ume l0 9ive aulhM�y to violale or cancol Ne prova�on o!any alher sLilo ar lo�il4iw regu�aLng construpian <br /> Thal I am auIDo�¢eE Cy Ne owner al M¢propaM b pedorm Na xo��or xM¢h aDW����6 maEe and I compN wiin t�e State Contrectors Law 1017 RCW and 1B6 20�A WAC. <br /> � � 6-,� ���y <br /> OwnerlAulhorizod Agent Signature Dale (Rovised fi?012) <br />