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<br /> CITY OF EVERETT PERM17" SERVICES
<br /> 3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org
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<br /> SITE ADDRESS: 7 v'� PROPERTY TAX f# PERMIT#
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<br /> LEGAL for ne�v construction: Short P!at/subdivision _ Lot No. (ailacf�copy of long legal descriotion)
<br /> OWNER ���lwaC>c'� l-�G�A_C i=�,,� PhonelE-mail � '�,;`��' -�'.1G� :�. L'Os:.�- �>>aAl�'�c�•.L• -iit c;
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<br /> APPLICANT:�Owi�er ___Owner's Agent _Contractor _Contractor's Ayent _Tenant�m�5i�ro��de a iE�iEr et��r,5er�t+r�m ine��;rer:o do„orK��,tr�e z��c��
<br /> CONTRACTOR (�e�.�;�^�C:� State Lic. # City Bus. Lic.#
<br /> Address " G1 � �. �`^ PhonelEmai�7�+ z�` � � (�.. ' i
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<br /> TENANT BU5INESS NAME CONTACT FOR PERMIT . �
<br /> �Vt;�:� �i�„s,,_i $> t�"Li„-T�3`� -Z`��..�
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<br /> \ �l,i�_�.. <E ' Phone;E-mail e.d`1�t�t i.���e '� �t,';'�id ,C�7,,
<br /> BUILDING PERMI7" APPL.ICA7�I�Id CONTRACT PRfCE OF WORK .� U'�
<br /> Existing Use of Building 'c=�.Sc�'c.'C�•.::.0 :.ti+�;:� �- '���c-.'_�L.�, HEAT SOURCE:
<br /> Pr000sed Use of Building �G���� Gas Electric Other
<br /> Building type: _Single Fai�ily _Dupiex__Townf�oGse ��Multi-Family `�Cornmerci�l
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<br /> ���%�Ji'. Oi z�iGf�'c'�i _ �`�2\^J i�C�CI`.IOII i�C.11ii�C�2�(����cjL�811 I � ��lll � �i''�.=•� �C'1110�ItIG11__�.�(12!lQ2 C1��5:;
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<br /> Repair, extend and test existing fire escape, install exit signs and emergency lighting, smoke and
<br /> carbon monoxide alarms, conect door paths and install new doors and provide�econd floor emegency exit
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<br /> Type of Project: __New_Addn _Aiteration_Repair Type of Project: _New_Addn _Alteration_Repair
<br /> Show Number(#)of fixtures Show Number(#)of fixfures
<br /> I A/C-air handiing units Toilet
<br /> ; Forced air systems ; Bathtub
<br /> " � Gas piping ( Lavatory (wash basin)
<br /> ! Water heater Shower
<br /> I Gas firaplace Kitchen sink&dispcsal
<br /> ! Gas range i Disn�-vasher
<br /> ; Clothes dryer C,oihes washer
<br /> � Ranae nood i Water heater
<br /> � Exhaust fan ; Sink(service(bar;mop!etc.}
<br /> � Heaf pump ! Backfiow preventer �
<br /> Unit heater i Urinal
<br /> ! Boiler Drinking Fountain
<br /> � Refrigeration i Floor drain
<br /> ( Woodstove � Grease trap
<br /> ! Ducting + Roof drains
<br /> � Other I, Medical Gas
<br /> SPRliVKLER / SUPPRESSIOfd SYSTEM Other:
<br /> 4 Number of Heads !, Other.
<br /> I F.ereby certify Ihai I have read ard exarn�ned this app!ication and kno:v the sam�to�c!rue and ccrrect.:�,!I prcvisions ef laws and ordir,ances governing this fype of�r.�ork will be ccmpli,�d
<br /> wfth�vhelhar specified herein or not.The granting of a permit does not presume to give authority to violate or canr,el ihe provision of any other state or local la�r�regulating construciion �I�
<br /> That I am aut�d by the uwner of;f�is prcpert/to perforn the work for tivhich application is made and i comply�vnh the Siate Con;ractors Law 1 t27 RCW ar.d 293200A INAC
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