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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: F--- <br /> ^ �� PROPERTY TAX# P,MIT,#L 1 <br /> . CD fit Q_ k . /=1/er�P7TiiiiY-1gR 1 unii- tii -000-UIIIL�-op ,�) 1 �l �1 rOOfi <br /> LEGAL for new construction: Short Plat/subdivision 00 to No.3-O attach copyng legal description) <br /> OWNERS 1 e, CIA r‘ 4-1 n Phone/E-mail ,l5— C(—)ir- Is A S-/Ge00 b(35 rn nal 0-1Z <br /> Address \ j i D$ ) eYC L. d City/State/Zip S no hn,ty)t chi Cv y} 32n1q oorj <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 r17 r; << in Q en-,08'F _I iAState Lie.# City Bus. Lic.# <br /> Address IN 0 k L_e V(t,.- c i ) ri nil n,m i 5 ( A C)a` Phone/Email � <br /> i, ' 1.0<,„U tic(7 <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> `"n v Phone/E-mail <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of Building OV/396 (--�JJ}2i�1Q/C'Sjd)/O/(o/Ae.UI� c�jG HEAT SOURCE: <br /> Proposed Use of Building �J �C100 <br /> r'L 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 /> 02 MID IC{ciL/Ss-hGP <br /> 'oveA,d --F-f o / ac pori---,i--, <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 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 /> Heatum Backflow preventer <br /> P p <br /> Unit heater Urinal <br /> Boiler Drinking Fountain <br /> Refrigeration Floor drain • <br /> Woodstove Grease trap <br /> Ducting I 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.-norm the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> 0 41 i -y--- <br /> o/i er/,uthorized Agent Signatu . O ate / (Revised 3/2013) <br />