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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 vi"I everettwa.org <br />SITE ADDRESS: f vlr Inr� PROPERTY TAX PERMIT d <br />��' y Pr)L�c9� 031 <br />LEGAL for new construction. Shod Plat/Subdivision Lot No.___ (attach copy of long legal description) <br />OWNER <br />I_ <br />PhonelE-mail `ia,f S�,Z '�-/L?1�-t <br />Address <br />Citylstele/zip <br />APPLICANT:_ Owner _Owners Agent _Contractor _ Contractor's Agent __Tenant(msr p.o.uao r;.er W."' acmar arrcl a db.n nme.p.ui <br />CONTRACTOR /t4UC,n 1 tt, � (n <br />State Lic. N MOCK P/ p? -- .3 J (� CityBus. Lic. x 05 SG3 S <br />Address 17515 Lit SGS4 L, N 4sszare) nonelEmal }�% <br />TENANT BUSINESS NAME I rU' rJ M1.11!')a.-,j,w . LCl+ <br />CONTACT FOR PERMIT <br />PhonclE-nail <br />BUILDING PERMIT APPLICATION <br />CONTRACT PRICE OF WORK <br />Existing Use of Building HEAT SOURCE: <br />Proposed Use of Building Gas_ Lld ric Other_ <br />Budding type _ Single Fomily _ Duplex _Townhouse _ Multi -Family _ Commercial <br />Type of project. _ New _ Addition Remodel _ Re air T.I. _ Sign Sprinkler Demoitlion Chan a of Use <br />_ <br />DESCRIPTION OF WORK (addlhonal space provided on Ine oachl: <br />T,154C II a" q1-j\/ L*f^ Is"jr-pnC�y{t <br />MECHANICAL PERMIT APPLICATION <br />PLUMBING PERMIT APPLICATION <br />Typo of Project- _Now_Aden_ritorition_Rapair <br />Show Numher (e) of Nrlw os <br />Typo of Project: _Now _Addn_Ahoranon_Repair <br />Show Numherl it) of rrxlunis <br />A7C—air handling units <br />I Toilut <br />I Faeer sterns <br />Bathtub <br />Ggs <br />Lavatory wash basin <br />Water heater <br />SI'OWer <br />I Gas fireplace <br />Kitchen sink & disposal <br />Gas ran e <br />I Dishwasher <br />Clothes dryer <br />Ck,theswasher <br />Range hood <br />Wat rheater <br />I <br />Exhaust fan <br />Sink (urvire/bar/mop/etc.) <br />_ <br />Heal ump <br />Backnow preventer <br />Unit heater <br />Urinal <br />I <br />Boiler <br />Drinking Fountain <br />RoMgerahon <br />Floor drain <br />Woodstove <br />Grease Ira <br />Ducting <br />Roof drains <br />Other <br />I <br />Medical Gas <br />SPRINKLER I SUPPRESSION SYSTEM <br />I <br />Other. <br />Number of Hoaas <br />Other. <br />I hereby R Kitt, That I It. mad end en,Md IMa opp&almn and know the same to ite wo and MMM Aa prwislone of Im a and mddtenaa soft" trb typo of wort, wa oe mmp.ed <br />wan wmtner epee fed harem or net The Wart" of a point, does not Wesi,nd to gNe ouTaNy to NOW a M tlrlml Ne rddNemn at Fry MW We a I,,al Iarr rep ,,q Wn1VUC en <br />That I am ovili iced by d¢ mria of rhls pmpedy to perform me wort tar w'ilan appUption a made Me I Lomp4 w:h the Stale CanVadan Law 1827 RC W and 298 200A WAC. <br />OwnerlAulhodred Agent Signature Date <br />(Rewsed 1-2010J <br />