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<br /> P:ERMiT �PPLiCATION `
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<br /> � BUCL�DING/M�ECHANICAL/PLUMBING�SI ' �
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<br /> GN/SPRINKLER/DEMOLITION
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<br /> `° : � CITY OF EVERETT;PERMIT SERVICES , ;:
<br /> 3200 Eedar St:, E�erett, WA 98201 425 257=8810 FAX 425 257 8857' www everettwa org
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<br /> SITEAD E S � �� PROPERTYTAX# P�RMIT
<br /> '�a��� w�:c.�sr�a �v 3 �vr�;�r:�� �� i� t� �7
<br /> ` LEGAL'for new construction: Short PlaUsubdivision : Lot No (attach copy."of long legal description) ,.-
<br /> OWNER .�b�' ��7 `a Phone/E-mail
<br /> Address �d" vu7�<3���'`, 17�S;D� 1� - City%State/Zip` S'[.!� 1 1�.� ,W.f7 �:�z'Q"',Z��,.
<br /> ` APPL`ICANT.?�Owne� Owner s Agent Contractor Contractor's Age�t Tenant�musc P�ovide a ieaer orconsent from,me ownar�o do v�oric in the space� ' '
<br /> CONTRACTOR .- �t,}� '.State Lic;# ��r l�(��� � ��City Bus;.;Lic.# �:�tp� '�
<br /> Address' Phone/Email �'
<br /> TENANT BUSINESS NAME ' CONTACT FOR PERMIT `
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<br /> :�� DC�A`f.�fL g a5 ��-o c��g � ,
<br /> Ftione/E-mail f�� , d(,,,5 ��
<br /> `, B�UILDING.,PERMIT APPLICATION coruTRacr PRicE oF woRK� _ ���:f�L� ':
<br /> ' Existing Use of Building =.��G . HEAT�SOURCE;
<br /> ° Proposed Use'of Bu�ltling M FG' �: � Gas:- Electnc Other. `
<br /> Building type , Smg,l,e Family Duplex`"'_'TownHouse �• ' Multi-Family �Commeraal -' ,, , '
<br /> Type of pro�ect:':_"New :�Atltlition ': Remodel ;_,Repair_T.1._Sign_9prmkler_Demolition �' Cliarige of Use
<br /> DESCRIPTION OF'WORK(atlditional space providetl on`the`backj
<br /> ' R�i�«��: �itrs�'�r�'�` t�'J�� �,�n �+��v,� ��W E✓�G�.� � . �,��s� 'y!'�� .�.�'- o�.
<br /> �li k+� �r�21�i�s'�8�-�:Raod?� S�'��. �u r�:ti����.�fi'..�� ��t� fi���� �aL-. �
<br /> MECHANICAL PERMIT'APPLICATION.�' P�.UMBING,PERMIT APPLICATION- `
<br /> Type of Project: _New_Addn, _Alterat�on=Repair.' Type of Project '"_New._Addn, _'Alteration• 'Repai� ,,'',.
<br /> ,Shonv Number(#):of fixfures Show Number(#)'of fixtures,
<br /> ` A/C�air handling units : ;Toilet
<br /> -� Forced airsy'stems ��� �.. '.=Bathtub,�:
<br /> ; Gas piping :Lavatory(wash basin)
<br /> Water::heater `. Shower:
<br /> ° Gas freplace-:_ � ';) "Kitchen:smk&disposal=:�: :
<br /> Gas range • Dishwasher..
<br /> ` Clothes dry"er'-;. - �, -: , Clothes Washer
<br /> ' Range;hood , Water heater. , ;
<br /> Exhaust fan � `.. :Sink(service/bar/mop/ete.),
<br /> � Heat pump�� �' "-� , :�� Backflow'preventer �
<br /> :Unit heater =.� Urinal� ';� �
<br /> Boiler y ;� :Drinking.Fountain
<br /> I' Refrigeration ;: ',� Floor drain
<br /> `- Woodstove Grease:trap
<br /> Ducting :) Roof`drains.
<br /> Other s Medical-Gas,..
<br /> , SPRINKLER;:/-SUPPR�SSION::SYSTEM. : � other:
<br /> Number of Heads Other�,
<br /> I hereby certify that I have read and examined this appllcation and know the same to 6e true and correct.All provisions of laws and ordinances goveming th(s type of,wo�k will be complied
<br /> with whettier spec�ed herefn or not,The granting of a;permft does not presume.ta give authoriry,to violate oc cancel theiprovfsion.of any othef state or local law regulating construction
<br /> That I am authorized by the owner of this property to perform the work for wtiich application is,made and I comply with tfie State Contractors l:aw 18.27 RCW and 296200A WAC. 'w,��:,
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<br /> Owner/Authorized Agent Signature Date
<br /> r � .: (Revised 3/2013)�` � ?� ,
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