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0 <br />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: <br />711-1 Hr-Yr Ave, <br />PROPERTY TAX a <br />PE IT 9 <br />Li for new construction. Short Plal/subdivision Lot No._ !attach copy of long legal description) <br />OWNER r✓e5 <br />Phone/E-mail G • j <br />Address 71L ill Ai <br />Cityistate/Zip LG✓P/gtf V./ Ze/ <br />APPLICANT: —Owner _Owners7Agent ionlractor _ Contractor's Agent Tenant (must provuealelter olconsenl lrom the owner •.o do work In the space) <br />'s <br />CONTRACTOR /�i7G//G Ir/Le /I7 <br />State Lic. IfAll //7G G L City Bus. Lic. #OS3 `'�S <br />Address Sc/G% /J'6 t/G V1 /`7 U/ S Ville, Wfl k.:2one/Email i — /SO] <br />TENANT BUSINESS NAME <br />CONTACT FOR PERMIT <br />PhonelE-mail <br />BUILDING PERMIT APPLICATION <br />CONTRACT PRICE OF WORK <br />Existing Use of Building HEAT SOURCE. <br />Proposed Use of Building Gas_ Electric-_ Other__ <br />Building type: _ Single Family _ Duplez _Townhouse —Multi-Family _Commercial <br />Type of project. _ New _ Addition _ Remodel _ Repair _ T.l. _ Sign _Sprinkler _Demolition_Change of Use <br />DESCRIPTION OF WORK (additional space provided on the back): <br />G/tan G�r�clY, y`n %✓uSer+onl <br />MECHANICAL PERMIT APPLICATION <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _Ni _Addn _Alteration _Repair <br />Show Number i or fixtures <br />Type of Project: _New _Addn _Alteration,_Repair <br />Show Number (q) or fixtures <br />A/C — air handling units <br />Toilet <br />Forced air systems <br />Bathtub <br />Gas piping <br />Lavatory (wash basin) <br />Water healer <br />Shower <br />Gas fireplace <br />Kitchen sink & disposal <br />Gas range <br />Dishsher <br />wa <br />Clothes dryer <br />Clothes washer <br />Range hood <br />Water healer <br />Exhaust fan <br />Sink (servicelbar/mop/elc.) <br />Heat pump <br />Backflow, preventer <br />Unit heater <br />Urinal <br />Boiler <br />Drinking Fountain <br />Refrigeration <br />Floor drain <br />Woodslove <br />Grease trap <br />Ducting <br />Roof drains <br />Other_ <br />Medical Gas _ <br />SPRINKLER I SUPPRESSION SYSTEM <br />Other: <br />Number of Heads <br />IU <br />Other: <br />hereby comfy 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 lype of work will oe complied <br />NO whether spe[diee 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 conslNdion <br />Thal I am authorized yAh r of this properly to perform the work for which application is me do and I comply with the Slate Contractors Law 16.27 RCW and 296100A WAC. <br />OwnerlAuthorizad Agonl Signaturo Date (Revised 32073) <br />