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• <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 /> SITE ADDRESS: PROPERTY TAX If PERMIT, A # �/ <br /> 100t l-1RR6oR V154./ LN, �55c —bc7O—d2.3 - Os '1A lL 06, _c0( <br /> LEGAL for new construction: Short Plat subdivision see Stn' (ALAN Lot No. _ (attach copy of long legal description) <br /> OWNER CAL 4 St tsali FI=(�C US O N Phone/E-mail 42.5 — 339 -Z 5-A 8 <br /> Address )OC3I 1.4 ArReotz, yt 5W L.N • City/State/Zip , WAs. _,Q9920-j <br /> APPLICANT: X 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 SELF State Lic.# City Bus. Lic.# <br /> Address S/srrn L Phone/Email ALS - 39 - 2.54 <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> N. CAL F u1 <br /> RG, 56N <br /> A' Phone/E-mail 4 415 — 76 -//2.931 ce i <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK_ Ski .00 <br /> Existing Use of Building R .1 Qt—uCE HEAT SOURCE: <br /> Proposed Use of�ng sAr,E Gas Electric__ Other <br /> Building type: Single Family X Duple __Townhouse Multi-Family Commercial <br /> Type of project: New Addition Remodel Repair X.T.I. Sign Sprinkler Demolition Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> REPLP/ CMC- iOt= r��Tr-_R.ioRATEP xT Rio R, WOO -t c pr S. <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New_Addn _Alteration_Repair it/^ Type of Project: _New_Addn _Alteration_Repair At j <br /> Show Number(#)of fixtures /u//� Show Number(#)of fixtures <br /> A/C–air handling units ! Toilet <br /> Forced air systems ! Bathtub <br /> Gas piping 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 Backflow preventer <br /> Unit heater _ Urinal <br /> Boiler 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 /> I hereby 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 WAC. <br /> Owne •ut ized Agent Sdrure Oafs (Revised 3/2013) <br /> L <br />