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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: PROPERTY TAX It E # <br /> G z t S411 .10i2- ,. EIcJ. ST i - OO9) <br /> LEGAL for new construction: Short PlatJsubdivisior A<JC ilk cG I?A'Z14- Lot No28..% (attach copy of long legal description) <br /> OWNER f],r<t t_ 1�At:,,ir►C_ .4cwrvl S Phone/E-mail (42S1 CIS-3 - Z e,,ciC 1 <br /> Address k Lc. S'a w a Vt`C"LiZZ I..",A. t. WArsA City/State/Zip Ell xt_• j . cl1 2 CA <br /> APPLICANT: Owner _Owner's Agent Contractor Contractor's Agent Tenant(must provide a letter of consent from the owner to do work.n the space) <br /> CONTRACTORS ../1.-V(. - AirC-1,jr am es State Lic.#5SA1TlltiC.tC;; i3 LL City Bus. Lic.#(.0t;'3 -Zl..,to • <br /> Address S Aop t. Phone/Email 5Atfv1,7._ <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT II:k-k-fV CalAtAf;•ZZc <br /> Phone/E-mail (.42-45 3`;, es -- 40,C Z_ <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of Building HEAT/ SOURCE: <br /> Proposed 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.1._Sign Sprinkler_Demolition TChange of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> Ici 5-fil L C2- GA-2 ) CiAst L c - t 41 1-- oil \ <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: ./'"New_Addn _Alteration_Repair Type of Project: 41ew Addn _Alteration Repair <br /> Show Number(#)of fixtures Show Number(#)of fixtures <br /> A/C-air handling units '3 Toilet <br /> 1 Forced air systems - i Bathtub <br /> 4 Gas piping 4 Lavatory(wash basin) <br /> ` Water heater 1 i Shower <br /> 1 Gas fireplace 1 Kitchen sink&disposal <br /> Gas range Dishwasher <br /> 1 Clothes dryer 1 Clothes washer <br /> 1 Range hood 1 Water heater <br /> O j Exhaust fan ` ; Sink(service/bar/mop/etc) <br /> Heat pump Backflow preventer <br /> i Unit heater Urinal <br /> Boiler Drinking Fountain <br /> Refrigeration — Floor drain <br /> --- Woodstove — Grease trap . <br /> Ducting La Roof drains <br /> Other -._-. Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM t Other: <br /> 1 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 al auth ed by the owner of this property to perform the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296200A WAG. <br /> j4-2-i s- <br /> Ow4C/Authorized Agent ignature Date (Revised 3/2013) <br />