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����'� ���������� <br /> �Ul�D�NC�16V1E�B��NICAL/PLl1N1�1NC�iSIGN/�PRINMCLE�IDE�ii�L��'1�N <br /> CITY OF EVERETT PERi1�1T SERVICE� <br /> 3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 vw�nn�.everet[wa.org <br /> SITEADQRESS: PROPERiYTAX# PE M,/�IT� <br /> �✓ � <br /> L.EGAL for ne�v construction: Short Plat/subdivision��12V—�� �ct ti �,t,�e,5� Loi No. (attach copy of long legal description) <br /> OWNER� LC,,, 1fc;,�. � �(►'1�C �j PhonelE-maily�-�s:�-a��.� Vllidlid/.`j�ct c�t��'�'t<5<CC) <br /> Address( O StN �ver�c� �^!1G�, t�ss �j:.0��Z (� City/5tate2ip ��J�y C� 'v:1r�, GI �S�D <br /> APPLICANT:�O�vner _Ovrner's Agent _Contractor _Contractor's Agent _Tenant�musi orov�ae a ieti>r o�co,sen�trom u,e c;:ner�o ao�•:orK;n me space� <br /> CONTRACTOR � <br /> S�a a.� o r�25 State�ic.#_ = ta�fT'� 00513� c�n,B�S. ���.�(�03- b-3 <br /> Address+��.SW �VL�� �1t W� ���e ��� �uC-c�l WA ��o�� Phone/Efifat�-`l� -.��L� iLuid/.bz�: •.c�c,-��".c��: <br /> TENANT BUSINESS NAME �CONTACT FOR PERMiIT <br /> '�c"('� �t7�c4�{7C:,c:.✓'� <br /> PhonelE-maii �,�j�31 S- y3(-��(1'K.i�.��5��,, ;c.�p/�r5.�uNh <br /> �I11L�1Ii1�`s PE�iM�'�' �PP�ICA'T60I� CONTRACT PRICE OF WORK <br /> a <br /> Exisfing Use of Building HEAT SOURCE: <br /> Proposed Use of Building Gas� Eieciric Other <br /> Buiiding type: �Single Family ,Duptex_Townhouse ^Multi-Family _Commercial <br /> Type of project: �New Addition P.emodel Repair_T.I._Sign_Sprinkier_Demolitian Change of Use <br /> rJ ES C R)PTI O r`! Q F�MO R(�(addition a!space p:ovided on the bacic�: <br /> �� <br /> 3�S� � I���-Y� � +- <br /> iV1ECHANBCAL PERM1�' �lPPLICATION �L�J11i1B1E1Ps PERMIT APPl.ICA'Y°ION <br /> Type ofi ProJect: �New_Rddn _Aiteration_Repair Type oi Project: _New_Addn _Alteration_Repair <br /> Show Num6er(#)of fiztures 5ho��lYumber(#)of frxtures <br /> � AlC—air handling units ! Toilet <br /> � Forced air sysfems Bathtub <br /> Gas piping i Lavaiory (�,vash basin) <br /> ( ; Water heater ; Snower <br /> 1 j Gas fireplace ; Kitchen sink&disposal <br /> J ; Gas range Dishv:�asher <br /> � � Clothes dryer j Clothes washer <br /> L � Range hood � N.�ater heater <br /> j Exhaust ian ; Sink(ser�ice/barlmop/etc.) <br /> � Heat pump � 6acRrlow preventer <br /> � Unit heater � Urinal <br /> ': Boiler ; Drinking Founiain <br /> i Refrigeration � Floor drain <br /> ; VVoodsfove � Grease trap <br /> Ducfing ! Roof drains <br /> j Other ! Medical Gas <br /> Si'RiN6CL.EEZ / SU�PRE�SI�i11 SYSTEM i Other: <br /> � Number of Heads � Other: <br /> 1 hereby ceAfi�that i have read and examined ihis applica6on and knor�the same to 6e true and conect.i.il provisions of taws and ordinances govemin9 this type ot work will be complied <br /> with��hether specifietl herein or not.The grenting of a permit tloes not presume ta give authority to violate ar cancel the provision ot any other state or Iowi I�v regulating construaion <br /> That I am author¢ed by the oemer of this property to per(orm the e;oric for rrhich appiication is made and 1 eompiy vrilh the State Coniractors La�v 18.27 RCW and 29"v.Z00A�NAC. <br /> �������.����--- � � �.� _�s , <br /> Ow�er/Authorized Agent Signatu�e Date (Revised 3I20i3) <br />