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PERMIT APPLICATION <br /> BUILDING!MECHANICAL/PLUMBING/SIGNISPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> !SITE <br /> Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br /> !SITE ADDRESS: 5+ _ PROPERTY TAX rt I I PEB ` ' <br /> �I <br /> I �13.2 ✓�, sg . (,L OD <br /> 1cZ-. <br /> LEGAL for new construction: Short Plat/subdivision -•N. =i e / Lot No. f_ (attach copy of long legal description) <br /> OWNER Al.kc, L)Iii + / -%I41 M c4c---JPhone/E-mail i.A)Pltiq-1-M..4 ()_, C Cr"Jl�,fsl . �J-j <br /> 'Address j 2.7 C- 0,..;.,.4‘ 5 . t,)` City/State/Zip ((eke S{t� ,v; t'.(14 , "2'56APPLICANT: Owner _Owner's Agent )(Contractor Contractor's Agent _Tenant(mustprovidealetterofconsentfromtheownertodowork inthe space) <br /> CONTRACTOR 1.C.IA e_.4 f C&N.i 4-0u:.C.T I ti%C( ,j ,C,.. State Lic. # j,(,)if EAT j(2,1 /e,:I 13 City Bus. Lic. # I <br /> Address ) 7 .3 Li ( <•Y b4. 'l Mkt SiC.i: x;11 C'! G;ri; Phone/Email 1L1 73C `S(y,/ 1-, - ` <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> 04tke. LL'IAea. <br /> f - / <br /> Phone/E-mail tet_ .• 7.1 • ,27z/ <br /> BUILDING PERMIT AFPLICATiON CONTRACT PRICE OF WORK <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building . 'i eL C f/n F4414 r r Gassy Electric Other <br /> Building type: ingle Family Duplex__Townhou/ _Multi-Family Commercial <br /> Type of project: X New Addition Remodel Repair T.I. Sign Sprinkler Demolition Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> 5FIR /g00 0 <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> J <br /> Type of Project: X New_Addn _Alteration_Repair Type of Project: X New—Addn Alteration_Repair <br /> Show Number(#)of fixtures Show Number(#)of fixtures <br /> I A/C air handling units Toilet <br /> Forced air systems 1 Bathtub <br /> .? Gas piping ) j Lavatory (wash basin) <br /> i Water heater l Shower _ <br /> I Gas fireplace Kitchen sink&disposal <br /> Gas range I Dishwasher <br /> I Clothes dryer / Clothes washer <br /> f Range hood Water heater <br /> ,-5 Exhaust fan Sink(service/bar/mopietc.) <br /> 1 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 /> 1 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 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 o perform the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> Z <br /> /l --� <br /> .',/26/15— <br /> Owner/Aut orized Agent Signature Dat (Revised 3/2013) <br />