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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# P um** , <br /> • • ! E. C- i• a •_. i1111 - pp <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> • OWNER NocoP, cn (NVcSrMt. ?tZ.TM.1Z Phone/E-mail 425 .387 51-(0 <br /> Address Z34- E 177,-IST )03 City/State/ZicaSTA Pi ESP. eA 9Z62:3- <br /> APPLICANT: <br /> Zc 2j -APPLICANT:_Owner _Owner's Agent _Contractor V-Contractor's Agentr_Tenant(must provide a letter of consent from the owner to do work in the space) <br /> CONTRACTOR rat l I X P)CSTbtZ.ATIta N State Lic.#f4ksC2.T8891T111/ City Bus.Lic.# <br /> ��/ 9 ;Z 1 <br /> Address 77& W. &T/AN RI STE 2-R Wt�UDiNv i(Lc Phone/Email ZOG44,S 3149 <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> �///��� � �n�,,� (� -5- - BI NFO R -C� @5C1E-SIE T <br /> Y V OQ 2-Q C. A QTg Phone/E-mail GJJ i 3 /v13I JeED <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK 851080 <br /> Existing Use of Building APA2-1-1.4‹-N7 S 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 V.-Repair T.I._Sign_Sprinkler_Demolition_Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back):4-t - <br /> c- 11)12 St _ . _. _ - - _ <br /> `MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Pro'ect: _New Addn Alteration_Repair T� a of Project: _New Addn Alteration_Repair <br /> Show Number(#)of fixtures Show Number(#)of fixtures <br /> NC—air handling units 4- I Toilet <br /> Forced air systems I Bathtub <br /> Gas piping Lavatory(wash basin) <br /> ater heater Shower <br /> fireplace A I Kitchen sink&disposal <br /> Gas nge Dishwasher <br /> Clothe dryer Clothes washer <br /> _ <br /> Ran*e h d Water heater <br /> S7 I Exhaust farillMil . 4 Sink(service/bar/mop/etc.) <br /> Heat pump 1 ckflow preventer <br /> Unit heater Uri I <br /> Boiler Drink! Fountain <br /> Refrigeration Floor dr 'n <br /> Woodstove Grease tra <br /> Ducting Roof drains <br /> Other \ I Medical Gas <br /> SPRINKLER/ SUPPRESSION SYSTEM I Other: \ <br /> 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 comp <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.. .e owner of this.operty to perform the work for which application Is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> t ffif <br /> Owner/Autho -d gent Signature Date (Revised 9/2014) <br />