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11 <br />PERMIT APPLICATION <br />BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 Cedar St , Everett, WA 98201 425-2 57-8810 FAX 425-257-8857 I -Aviv, everetitva org <br />it <br />SITE ADDRESS: v <br />a&3/ G wny d��e•r <br />PROPERTY TAX <br />3-DD2-oo2-� <br />P RhiIT# <br />- co <br />LEGAL for new construction: Short Platfsubdiviswr�e/ 5. F _ Lot No (attach copy of long legal description) <br />r _// / <br />OWNER 1 /&)05� Ui>Q 2 <br />'none/E-mail U - / :0 <br />U <br />Address 3Y50 GT <br />cry/staltrzip /71a12//-)/AA/ /fD g 3105�2 <br />APPLICANT: ::vmer Owners went _-Ccnbactor _Contractor's Agent Tenant lm�st;rm!oaier.erat consmu:om ea o.ner to do+on m•.nn seacsl <br />CONTRACTOR ,tj _ �E]-�" II11VEZ) <br />State Lic # City Bus Lic d <br />Address Phone/Email <br />TENANT UUSINESS NAME <br />��^' , / <br />�/A4( SbA1S S�/eE /v0. IO�Z <br />CONTACT FOR PERMIT C- l Py/7,7Pr- <br />exai2 i7duSeJ J s //1/ G <br />Phone1masi <br />BUILDING PERMIT APPLIC/AIT,I"ON <br />CONTRACT PRICE OF WORK <br />��II <br />Existing Use of BuildinlQ //'g !�i?-A ��HHEAT SOURCE <br />Proposed Use of Budding V el C�-�fl�N Gas_-__ Electric.?<, Other___ <br />Building type: _ Single Family _Duplex _Townhouse _ hdulti-Family x Commercial <br />Type of project _ New _ Addition _ Remodel __ Repair _ T.1. _ Sign _Sprinkler emoldion_Change of Use <br />DESCRIPTION OF WORK (additional space provided on the back): pernp �$ 2}cIS111�9 5 t ore, Caf ci�i, �.P c0.ho p/�/( <br />MECHANICAL PERMIT APPLICATION <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _Now _Addn _Alteration _Repair <br />Show Nurnber(#) of fixtures <br />Type of Project: _New _Addn _Alteration _Repair <br />Show Number(#) of fixtures _ <br />A/C - air handling units <br />I Toilet <br />I Forced air systems <br />I 8alhtub <br />Gas piping <br />Lavatory (wash basin) <br />Water heater <br />Shower <br />Gas fireplace <br />I Kitchen sink 8 disposal <br />Gas range <br />Dishwasher <br />I <br />Clothes dryer <br />I Clothes washer _ <br />_ <br />Range hood <br />Water heater <br />Exhaust fan <br />I Sink (servicelbarfmopletc ) <br />Heal pump <br />I Backflow prevenler <br />Unit heater <br />Urinal <br />Boiler <br />I Drinking Fountain <br />I <br />Refrigeration <br />_ I <br />Floor drain <br />I <br />Woodslove <br />I <br />Grease trap <br />Ducting <br />Roof drains <br />Other <br />Medical Gas <br />SPRINKLER / SUPPRESSION SYSTEM <br />Other: <br />Number of Heads <br />i <br />Other: <br />I hereby certify that I have read and examined this aforcatlon and know the same to be IMe and conecl. All pmvis:ons of lams and ordinances govemtng In is type of work Ml be complied <br />willwhether specified hetl>n or not. The granting of a permit does not presume to give authority to violate or cancel the provision of any other slate or local Iawreguming constniction I <br />That I am authorized by the ovner of this property to perform the srotk for which application Is made and I comply with the Stale Contractors Law 18 21 RCW and 296200A WAC. Z <br />�.� Q <br />OWneriA oriz Agent Signature Gate <br />(Revised 3y201J) <br />