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<br /> _ P;�RMIT�AP�PLI.CATION
<br /> _ � BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION';
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<br /> � � � �� CITY OF EVERETT PERMIT SERVICES
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<br /> 3200 Cedar St;, Euerett, WA 98201 425 257 881 Q FAX 425 257 8$57` www evereifwa o.rg
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<br /> SITE AD E S - ' =' �� J PROPERTYTAX# t'P IT#
<br /> h:�D��3 W CASrNo �-� �v�:�'f�6I�6��- � � -� =���-
<br /> ' LEGAL for new construction -Stiort PlaUsubdiwsion:- `f' ,� w Lot;No (attaeh copy,of long legal description)`,,
<br /> �6�'.! � ,; <«
<br /> OWNER � Phone/E-maii '`�
<br /> : aad�ess' ,�0.P�6�:.3'1�-T ;�'1 t:S ��t"1-J. , ; , City/State/Zip "�[.II 1, 1���W�I .°I�`12,�9' ��0�7
<br /> -'APPLICANT..�Owner Owner s Agent _Contracto� C011tt'8Ct01''§Ag2ht.,; Tet1811t(must prowde a lefter of consentfirom the owner to do work lo the space)
<br /> CONTRACTOR „�(j�j `F : Q� _ State Uc:# 'f,�%��� l�J�,�; {' ` ,�City,Bus..'Lic.#. `: ��I�
<br /> Address: - ' � ''
<br /> Phone/Emaii':;
<br /> �_TENANT BUSINESS NAM� CqNTACI'FOR PERMIT ° '
<br /> > -. , ..,� �� � .;. :��'� `�'' � ��oZ 7..��'Ob`�,
<br /> � �,' � �-
<br /> - 'DCZA 5 �
<br /> Phone/E=mail f��' ' (�d. �"
<br /> BUILDING:;P�RMIT APPLICATION � CQNTRAGT PRICE OF-WQRK �'�",�G��J�'���;''"
<br /> , ExistingUse;ofBuilding' `���- :� HEATSbURCE:
<br /> Proposed Use of Building M FG " Gas: ' , Elec4r�c ^ Other `
<br /> :Building type, '�Single Fam'ily Duplex- '_Townhouse ? Mult'i-Family`,�Gorrtmercial=-;
<br /> Type of project:;_;New,_Addition��Remodel _Repair_T.;I,'_Sign_Sprinkler_Demolition ' Change of Use
<br /> DESCRIPTION OF WORK(addihonaf,space prov�ded on the backj ; ° : ,'.
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<br /> �'�N��1'#bb.f1� :5�- �Iefii,�'R;1�l�r�l�il►.'3�Y�. �[!"5'D. BED� ..,i�I�.GO�.'- G�IID�iNl�4J�S �
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<br /> MECHANICAL PERMIT APPLICATION . t :P�:UMBING,.PERMIT APPLICATION
<br /> Type of Project: _New`�"Addn'TAlteration-_Repair` Type of Pro�ect i New_:-Addn ,_Alteration_Repair ,'"
<br /> Sho�v Number(#J of fixfuces . Show�Number(#)of flxtures .
<br /> = A/C='air handling.units Toilet '-
<br /> Forced.air systems 'Bathtub
<br /> Gas:piping Lavatory(wash;6asin)
<br /> � �'Waterheater -: - � ��howei-�-;
<br /> �Gas fi[eplace :� •. •' '� Kitchen sink&disposal�,,
<br /> Gasrange �. : Dishwasher '
<br /> Ciothe"s dryer � �;Glothes.waslier; ,
<br /> -'- Range=hood VNafer heater., ,'
<br /> . Exhaust fan " �Sink(serviceibar/mop/etc)�
<br /> �' Heat pamp ( Backflow,p�evenfer.
<br /> <Unit heater � ° llrinal ;
<br /> �;� Boiler�� � �. �;i� ���"��Drinking:Fountain '
<br /> ` Refrigeration Floor.drain
<br /> � �� Woodstove` � ���Grease:_trap �
<br /> ' Ducting "Roof drains
<br /> Other Medical Gas•: '
<br /> SPRINKLER,/.SUPPRESSION'-SYSTEM . Other: :; .
<br /> 'Number of Heads � • Other:, >
<br /> f hereby certiry that I liave read end examined this apphcation and know the same to fie true and correct.All provisions of laws and ordinances govetning thfs type of work will be complied
<br /> with whether spec�ed herein or:not,The granting of a'permft doe§not presume ta give authorky,to violate oecancel the provision of any other state or local law regulating construction ;
<br /> That I am authorized dy the owner of thfs property to perform tha work for which applfcatiori fs,made and I comply wfth tfi�e State Contractors Caw 18.27 RCW and'296.200A 1NAC.
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<br /> °1� 't',� /S''
<br /> Owner ori e A ent Signa e` . Date
<br /> , ;._ : (Revised 3/2013)
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