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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 /> G IG05—©al 1 <br /> SITE ADDRESS: Z!O Z 0,6%k-1`SROPERTY TAX# PERMIT# <br /> Aveve00 3-79 Y3?6'3/o?... + <br /> LEGAL for new construction: Short Plat/subdivision EvERETT b+v g'1-y3 Lot No.31 3L (:f cch copy of long legal description) <br /> OWNER P4VL o 1Lf 13E2N/44R-D Phone/E-mail 4 a 5 308 efo1a3 ?-s-2s2. a7jl <br /> Address 7/04 D,4WES A-V E City/State/Zip iS,reA2E f" bt/A 4920/ <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 PA 6A•CA-6.e kS. State Lic.#PbG►F6.1 o8,9 5ti City Bus.Lic.# <br /> Address 2.004 Lb- )i AVG' Usurp g F_vc¢GT;L-vA 4 2ol phone/Email 1+2.-S 5'6 4F752 <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Phone/E-mail <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK 44600 <br /> PO" <br /> Existing Use of Building 5I/v4[& FQi risy )t 6 HEAT SOURCE: <br /> Proposed Use of Building 242A66/rC4aRbR_T 1M6Ale Gas Electric Other v� <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 /> CvN'572 v cy /0/ `r Lb/Gt,Q,q./1.0G.QRP02T *'r4CM72a 6—ie— Si-M . 140/44 CA-rT� ,s 122Eraat, fiery <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 I `/V. Toilet <br /> Forced air systems -I Bathtub <br /> Gas piping ✓ Lavatory(wash basin) <br /> Water heater Shower <br /> Gas fireplace I Kitchen sink&disposal <br /> Gas range - Dishwasher <br /> Clothes dryer Clothes washer <br /> Range hood I / Water heater <br /> Exhaust fan Sink(service/bar/mop/etc.) <br /> Heat pump I 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 I 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 comp) <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 a orize y�th�e owner of tthii,property to perform the work for which application Is made and I comply with the State Contractors Law 18.27 RCW and 298.200A WAC. <br /> Owner/Authorized Agent Signature Date (Revised 9/2014) <br />