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0 <br />11 <br />PERMIT APPLICATION <br />BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKL.ER/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 />I I $ rc 51, <br />PROPERTY TAX # <br />PERMI <br />p.,o J M <br />!�� (oJ <br />LEGAL for new construction. Shod PlaUsubdivision Lot No. - (attach copy of long legal description) <br />OWNER <br />Phone/E-mall I''f+ %-e_ Lo (r i�v <br />Address t (a I t ( R" Sk <br />Citylstatelzip f` --' eA f Lwr & 5 V I <br />APPLICANT: —owner _Ovmner's Agenl _Contractor _Contractors Agent _Tenant(muuusst pro�inoraalletter or¢nsert tons tnu corner to co wo* in mu spam) <br />CONTRACTOR /L4UL,, Y (e-,r-i �'r r n <br />Slate Lic. # MGC(x (/ 'hC 6 .jam i..) City Bus. Lic. # 05 3(o S S <br />Address %S(S L"i(�si" 5� Soo 0n••SL. l,.l la 4S'2�rU <br />4yl$ 76:V 5'16U 1 <br />Prone/Email Iren�r M�lw-,�cam <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 />Propc-ed 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 baek): <br />To 5 )z 11 T' 13 ti/ V <br />MECHANICAL PERMIT APPLICATION <br />PLUMBING PERMIT APPLICATION <br />Type of Project. _New_Addn _Alteration _Repair <br />Show "umber (#) of fixtures <br />Type of Project: _Now_Addn __Alteration _Repair <br />Show Number (#) of fixtures <br />A/C — air handling units <br />I Toilet <br />- Forced air systems <br />Bathtub <br />Gas piping <br />Lavatory (wash basin) <br />Water heater <br />Shower <br />Gas fireplace <br />Kitchen sink B disposal <br />Gas range <br />Dishwasher <br />Clothes dryer <br />Clothes washer <br />Range hood <br />Water heater <br />Exhaust fan <br />Sink (service/bar/mop/etc.) <br />Heat pump <br />X <br />Backflow prevenler <br />Unit heater <br />Urinal <br />Boiler <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Refrigeration <br />_ <br />RWoodslove <br />Ducting <br />Roof drains <br />Other <br />Medical Gas <br />SPRINKLER I SUPPRESSION SYSTEM <br />Other: <br />Number u1 Heads <br />I <br />Other: <br />I heref j aerbfy that I have read and examined this application and know the same to be true and comet. All provisions or laws and ordinances governing this type of work va!I be complied <br />with whether specified herein ar not. The gre hiring of a pennd does nor presume to give authority to violate or carrel the proilslon of any other stale or local law regulating construction <br />That I am authorized by the owner of this nmperty, to perform the work roc which applimticn Is made and I comply with the Stale Contractors Law 18.27 RCW and 296.200A WAC. <br />Owner/Authorized Agent Signature Date <br />(Revised 312013) <br />