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iijit.t>ci\) 6 t E' <br /> PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br /> "Ver,5.I O 10 3 z Pt <br /> SITE ADDRESS: PROPERTY TAX# PERMIT# <br /> I d 5-Zg -ctr‘4 - 5S ZBD,r/9VO/03Y'OtD (I_ADR' OP(v <br /> f°*111441r0 VF 6C• • <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER I T114t C. M' 1-LG Phone/E-mail Les het main a pa.4 A t ria a knme .CAM <br /> Address I79Z1 to-mat-evelaIT twit StxT6 Iry City/State/Zip g01145u._ r U.1A.. q0(2- <br /> APPLICANT: <br /> APPLICANT: Owner ✓Owner's Agent _Contractor _Contractor's Agent —Tenant(must provide a letter of consent from the owner to do work in the space) <br /> CONTRACTOR State Lic.# City Bus.tLic.# <br /> Address SCIM"Q QS above. Phone/Email Stout tar abote <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Phone/E-mail S-CLIAAP.,CL X13 OW_ <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK f 2.2.6,P a' <br /> Existing Use of R„itd;-- N/A HEAT SOURCE: <br /> , <br /> Proposed Use or buliding_ P rA C-44S1> Cz/AASGas %/... ElectricOther <br /> Building type: ✓Single Family —Duplex ✓Townhouse ✓Multi-Family _Commercial <br /> ,^Type of project: % New _Addition _Remodel _Repair T.I._Sign Sprinkler Demolition Change of Use <br /> iESCRIPTION OF WORK(additional space provided on the back): <br /> 1461.0 ICUM ioa6 \M -rE- 1 F-5I61-03 = UJO9 <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: ✓New Addn _Alteration_Repair Type of Project: ✓New__-Addn __Alteration_Repair <br /> Show Number(#)of fixtures Show Number(#)of fixtures <br /> A/C-air handling units 4 Toilet <br /> ( Forced air systems t2 ( Bathtub <br /> Z, Gas piping J ( Lavatory(wash basin) <br /> / Water heater / Shower <br /> Gas fireplace / ( Kitchen sink&disposal <br /> • Gas range / ( Dishwasher <br /> Clothes dryer / { Clothes washer <br /> / Range hood ) Water heater <br /> Exhaust fan • Sink(service/bar/mop/etc.) <br /> Heat pump I ( Backflow preventer <br /> Unit heater ( Urinal <br /> Boiler j Drinking Fountain . <br /> Refrigeration Floor drain • <br /> Woodstove ( Grease trap <br /> Ducting ( Roof drains <br /> Other Medical Gas • <br /> SPRINKLER I SUPPRESSION SYSTEM I Other: <br /> Number of Heads Other: <br /> ._„ereby certify that I have read and examined this application and know the same to be true and correct.All provisions of laws and ordinances governing this type of work will be complied <br /> with whether specified herein or not.The granting of a permit does not presume to give authority to violate or cancel the provision of any other state or local law regulating construction <br /> That I am authorized by the owner of this property to perform the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200A W <br /> _JO I,ei.eoly V .a. , <br /> Owner/Auth• .. Agent Signature Date (Revs ) <br />