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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: r PROPERTY TAX# 1 T <br /> a it cvc.1.a f . #tett 7 QOM` 61( ooi oo-7OO W 4ia - O03 <br /> LEGAL for new construction: ShortPlat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER ‘./ cO t l A4 of Phone/E-mail L51.10c41)VAC! p Atim000d.Co?'A. t� <br /> Address 805 Ai pi. Dv-tVC_ City/State/Zip 4.. ..pt-tt- OA 98�cZ,3�t2.s-7�o0— p-, it3 <br /> APPLICANT: v Owner Owner's Agent ^Contractor Contractor'sppAgent _Tenant(must provide a letter of consent from the owner to do work in the space) <br /> CONTRACTOR )uSs441 C. ?rate,' tTPeceasec9) State Lic.# City Bus. Lic.# <br /> Address Cu)0. ' <br /> SiS7 ,q t"!I UCY,[tG-// OA 92293 Phone/Email <br /> TENANT BUSINESS NAME "CONTACT FOR PERMIT <br /> C0.5tack )tette t`nnett,vKtr,u,6..r,t.. 142.5-7 C) —1-fiLf <br /> Phone/E-mail <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of Building Cori el()rvl t t^,ttA vv HEAT SOURCE: <br /> Proposed Use of Building t t CO:Dc Gas_ Electric Other_ <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 /> DESCRIPTION OF WORK(additional space provided on the back): <br /> Cebej l`�'"/a(Wit h QGGr144Cie O3 147 <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 /> NC—air handling units Toilet <br /> Forced air systems j Bathtub <br /> Gas piping I Lavatory(wash basin) <br /> Water heater Shower <br /> Gas fireplace I Kitchen sink&disposal <br /> Gas range Dishwasher <br /> Clothes dryer r Clothes washer <br /> oZ Range hood i Water heater <br /> 3 Exhaust fan • I Sink(service/bar/mop/etc.) <br /> Heat pump Backflow preventer <br /> 4 Unit heater Urinal <br /> Boiler Drinking Fountain <br /> Refrigeration Floor drain <br /> Woodstove I 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 /> -C)5C/LA)-tktLe—t9---- o..51-tcf <br /> Owner/Authorized Agent Signature Date (Revised 3/2013) <br />