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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 /> 931 <br /> SITE ADDR SS: PROPERTY TAX it PE IT# <br /> y. � de-. s ••• Ivc&v-T S o�,-nl S <br /> LEGAL for new construction: Short Plat/subdivlsiorCA C&de ?AQ-%L Lot No 2-t (attach copy of long legal description) <br /> OWNER C p t Lye_ c)AG.. t C_ k.ovvi tvc S Phone/E-mail ("4Z'",9S-3 2-$04C) <br /> Address %'La s w a ded_F�f MlikA._lA>A.-.4 City/State/Zip EJ war Cm". • CtQs2.CsQ <br /> APPLICANT:„Owner _Owner's Agent _Contractor _Contractor's Agent _Tenant(must provide a letter of consent from the owner to do work in the space) <br /> CONTRACTOR SW- T(jL ?AcC 4t(_ 1. ' i,t .S State Lic.#SEATTPIACOS-ES 0 City Bus. Lic.RAS-Z-Leta, Sc <br /> Address 5 ilb.Akre,. Phone/Email 51260AA I_ <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT StkIQC�cD c ,r,3.Z <br /> tC�.� <br /> Phone/E-mail (47-5.\ 34-0 - .Q0 2— <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: 1/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 back): <br /> 14 t cers ?L.P..-..) -Z c- 'z. ci".2otg�z iB 0,9.t * ( 3 i 4 O 3 - o®Y <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: ' New Addn _Alteration_Repair Type of Project: r'New 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 �. Bathtub <br /> 4 Gas piping 4 Lavatory(wash basin) <br /> to Water heater i Shower <br /> i Gas fireplace I Kitchen sink&disposal <br /> V Gas range 1 Dishwasher <br /> t Clothes dryer t Clothes washer <br /> Range hood __j✓ <br /> LQ Exhaust fan t Sink(service/bar/mop/etc.) <br /> Heat pump Backflow preventer <br /> -- Unit heater ....- Urinal <br /> — I Boiler Drinking Fountain <br /> Refrigeration Floor drain <br /> --- Woodstove -- Grease trap • <br /> Ducting LO Roof drains <br /> Other — Medical Gas <br /> SPRINKLER I SUPPRESSION SYSTEM Other. <br /> 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 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 298200A WAC. <br /> a/I ` 3' to-l S I/2 <br /> Ow rlAuthorized Agent ignature Date (Revised 3/2013) <br />