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PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLE /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 /> 1) I30(0 - c� <br /> SITE ADDRESS: PROPERTY TAX# PERMIT# <br /> I x313 P'1 k,0 ( 4 0050 5'7 0000 8 ,.- 1/6/,.- 1/6/Z1-- 50 �°/3-00 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER � ) p) �,��� L� (a/2t\.), Phone/E-mail L� j—23_4(0/7 ARAIC',46,c Is, .<_ <br /> Address 5 C OeSr <br /> APPLICANT: x Owner _Owner's Agent _Contractor _Contractors Agent _Tenant(must provide a letter of consent from the owner to do work in the space) <br /> CONTRACTOR 5 G`l e:-Tx eAci t t)5 JState Lic.# ` C//e 2'17/f4�+� '-City Bus. Lic. # <br /> Address 167 tst4,0L,AzzodLs/ �(`S-j IPhone/Email /7< - / �T <br /> TENANT RUSlNESS NAME CONTACT FOR PERMIT 12/Y! en` ,..! e- <br /> tas= 231- 'tog? <br /> Phone/E-mail J,QNe ,0 5 Gt 24,0Eif /t!C'T <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building 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): —r-b P ryt ov --rkto �'?(r Ti itl if-0 e <br /> cvL 4 Tc.-) Lert SL OLS P(, -r . <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 /> —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 /> ,F1A • •— a- <br /> Owner/Authorized Agent Signature Date (Revised 3/2013) <br />