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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 /> 1131g <br /> SITE DRESS: PROPERTY TAX# E T �f) <br /> t 1 C-42-4 d2.5 .kiF1-E 1T er b 4 ()ca. <br /> LEGAL for new construction Short Plat/subdivisionC& .AClG t?At 1_% Lot No.tCt (attach copy of tong legal description) <br /> OWNER pit 1 t...2_ �A(..,r lC_ `4pyvt i.S Phone/E-mail (425 CIS ? - 2 e.�C)Cs <br /> Address f!tc. S v,1 cZ yr`ti.. -Il ittm4%.- tAms...l City/State/Zip Ei)f)e_a_1 • cif 2C <br /> APPLICANT: Owner Owner's Agent _Contractor Contractor's Agent Tenant(must provide a ieiier of consent from the owner to do work.n tits space) <br /> CONTRACTOR Sri.A►'-i ijL t,AcC.A,t tL (4 - %4 .S State Lic.#SCafsTCPtiCtr,,,S 13 L; City Bus. Lic.#(,,t'3 •Z-(.4.40.-7-A: <br /> Address 'j/.1yykrE, Phone/Email 5AA,7._ <br /> TENANT BUSINESS NAME CONTACT FOR PERMITc <br /> -TC.E-k-N Ca-a w Z—C`- <br /> Phone/E-mail 64Z.'j, 3g„-c, -- 40_0 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 /> P _ _ y <br /> Type of project: V'New Addition T,Remodel Repair T.I. Sign Sprinkler Demolition Change of Use <br /> DESCRIPTION OF WORK(additional space provided cn the back): <br /> t$1 '°LAS . C LA:2-. ) gikstC_ 1zr3- 1 40% -00 t <br /> MECHANICAL PERMIT APPLICATION `PLUMBING PERMIT APPLICATION <br /> Type of Project: '"New_Addn _Alteration_Repair Type of Project: 4Iew Addn _Alteration_Repair <br /> Show Number(#)of fixtures Show Number(#)of fixtures <br /> — ( A/C-air handling units " Toilet <br /> i Forced air systems 2. <br /> . Bathtub <br /> 4 I Gas piping 4 i Lavatory(wash basin) <br /> ‘ Water heater t Shower <br /> 1 ( Gas fireplace I Kitchen sink&disposal <br /> 1 i Gas range t • Dishwasher <br /> Clothes dryer 1 Clothes washer <br /> I, i Range hood i Water heater <br /> t Q j Exhaust fan 1 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 to Roof drains <br /> Other -.— Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM Other: <br /> I Number of Heads I Other: <br /> I hereby certify that I have read and examined this apphcation and know the same to be true and correct.All provisions of laws and ordinances governing this type of work wilt 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 ether state or local law regulating construction <br /> That I ark auth ized by the owner of this property to perform the work for which applications made and I comply with the State Contractors Law 18.27 RCW and 296 200A WAC. <br /> 4-7-15- <br /> /Z- <br /> Ow‘/Authorized Agent ignature Date (Revised 3/2013) <br />