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<br /> � PERMIT:i4PPLiCATION ; �..; � _
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<br /> BUILDING/�U�ECkIANICAL/PLUMBIIVG/SIGN/SPRINKLER/DEMQLITION:
<br /> ` -' C17Y OF EVERETT,PERMIT SERVICES
<br /> 3200 C.edar St:, Everett, 1/VA 98201 425 257 8810 ,FAX 425 257 8857 www everettwa org
<br /> ;SITEAD E S , r.` 2 � PROPERTY`jAX# +'. � RAQL�# `
<br /> v �D�� W �1SIN� �.D:' �il�P.,E�[' ��- y . � .,� ,� Q3 '
<br /> LEGAL for new eonstructlon Short PlaVsubdivision = �� Lot:No. (attach copy of long lega)description) ",� .
<br /> OWNER �Q,���` �` r ` Fhone/E-mail ' 4
<br /> Address' �D W 1�:.,3`;1�� ��I S D 4�a'� J' City/State/Zip,,.�[.s�'1 t L,r,, ;VV f7 -1 b;�Z,'�''����
<br /> APPUGANT;:�Owner; O.wner's Agent _Contractor Contractor's Agent Tenant�must Prowde aiener or conSaoCfrom ina owner�o do�worlS In the space)
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<br /> CONTRACTOR �U - �.�I"�f `;GN� �_:. . State Lic:# "�'"L� ,�.�'��.�•.. . ,�.-. Gity Bus.<Lic:#=(�'5�0���� ,
<br /> Adtlress; - Pho.ne/Email =
<br /> TENANT BUSINESS NAME CONTACT:FOR PERMIT '
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<br /> �� :DC�A`i;�AL q�5 ��'0 Z��d �,.
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<br /> � ,-` ' - �� PfionelE-mail: � �
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<br /> ' BUILDING.PERMIT APPLICATION ` CQNTRA.CT PRICE OF WORK .��R�-i��C14 �: .; '
<br /> �� .''Existing`Use''of Building,°` '��� •' " .HEATSOURCE;'`
<br /> Propo`sed Use of Bualding M FC7' `: Gas_ Electric %�other
<br /> Building`type: !T Sirigle Family _,Duplex -_Townhouse � ` Multi Family �Commercia) _
<br /> Type of:project:;_New "�Addition :�Remodel;:- ' Repair_,T.I.._Sign- '' Spr'inkler_De,molition_Change.of Use
<br /> DESCRIPTION OF WORK(add�honal space p�ovided on'the back)'
<br /> �'��� r��w .��'y�x�����i� �����a� �a� ;�� i�-ni��r�,�.. 3,6��g s��r �;r��r.�,c;� s�r�
<br /> �!� 3�"D�JJ� �t�3`�'�a�` ,N,Gaa,r �'��6� �'`�tF� a�r��cc.YB�, R�vt�'ro,cls 'i�?•�',€7`�1,u1� Pc�►?,�' ��-1,.�
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<br /> SE.=I�� S�� � 1�J��`� �i'�i� '.1J f� S. :s�u G�- ���' a�J� �� ,;
<br /> MECHANICAL PERMIT'APPL'ICATION ; PLUMBING,PERMIT APPLICATION
<br /> Type of Project: _New_Atldn �_Alteration.=Repeir`: Type of Pro�ect:_New_Addn, ,_Alteration._Repair, ,;
<br /> =;Shoyr Number(#)of fixtures Show Number(#)of fizfures!
<br /> '; A/C'=air handling units Toilef�
<br /> ° Forcetl'air systems °Bathtub
<br /> ( : Gas piping Lavato.ry(wash basin)
<br /> Water;heater .;' ., Sh,ower° �-
<br /> ` Gas f replace ".:; ; ` Kitchen sinK&disposal",
<br /> :: Gas range , ; Dishwasher
<br /> Clothes d.ryer - .,.Clothes washer
<br /> : Range hood ' VVater heater , `
<br /> % Exhaust,fan ' . `Sink(service/bar/mop/etc:):
<br /> � Heat pqrrip ' '� : :Backflow preventer
<br /> �Unit heater ; U'rinal ::`
<br /> ', : Boiler ' - Drinking'Fountain
<br /> ' Refrige�ation. ; Floor drain
<br /> Woodstove Grease'trap
<br /> Ducting Roof'drains
<br /> :Other : Medical Gss{-
<br /> SPRINKLER /:SUPPRESSION:SYSTEM', ,`- Other:. •
<br /> `Number of Heads Otlier:.,
<br /> I hereby certify that I have read and examined this application aad know the same to 6a true and correct.All provisions of laws and ordinances goveming this type of work will be complied
<br /> with whether specifed herein o�not.The granting of a'permd does not presume ta gfve`authorfly to violate or cancel the provision of any other state or local law regulating construction ;
<br /> That i aro,authorized by the owner of this property to pertorm the work for which application Is made snd I comply wfth the State.Contractors Law.18.27..RCW and 296.200A WA ���
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<br /> OwnedA' h ' ed g nt Signature Date
<br /> (Revised 3/2013)
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