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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 RMIT# <br /> 11030 " t �S — Zf3o519003t01 POO I �c�"( `'� <br /> .7R4 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> t�I <br /> OWNER NOCD C IMW1 f-i N'1?2TMt 2 3 Phone/E-mail 425 3&3 53..(0 <br /> Address zsei. E 177"ST 14)o3 City/State/Zip TA Es,e 9Z(2-3- <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 jEN 1 X fEATiQN State Lic.trat-AelZieeli TIA/ City Bus.Lic.# <br /> Address��33 W. T/AN 121NSTE 1-R \OODINv 1 L Phone/Email Zo641,S 349 <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> \n I F SSS �I NFO 1Z, G$CI6..146 T <br /> V �l Dor)E2 otc APT Phone/E-mail2S3 63SS S S-F-i-tv�iom,1A1ap2y <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK 850,0 <br /> Existing Use of Building AFA2-TMFN T 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):' pi g 1pAto.G-ED h1'ToRto 2_TNt5M E.S <br /> I SIDING, 5oFFI1- IOC ,Zai• 3o"2% f9CPA'R lta RAcc. TQVSSE. S <br /> 17ECK 1 1 L @ UNIT & L NCw ROOF SHett7Hlr\)(-ci2oco? Ivo-@ TtZvss 1ZE�1+Ift <br /> LOCLY1ttg <br /> ECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of P •'ea: _New_Addn Alteration_Repair T .e 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 1 Bathtub <br /> Gas piping Lavatory(wash basin) <br /> ater heater Shower <br /> fireplace Kitchen sink&disposal <br /> Gas .nge Dishwasher <br /> Clothe• dryer I Clothes washer <br /> Range h••d Water heater <br /> _5 Exhaust fan 4- Sink(service/bar/mop/etc.) <br /> Heat pump .-ckflow preventer <br /> Unit heater Uri .l <br /> Boiler Drink'•• Fountain <br /> Refrigeration Floor dr.'n <br /> Woodstove I Grease tra: <br /> Ducting I Roof drains <br /> Other Medical Gas <br /> SPRINKLER/ 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 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. perty 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 lif �w <br /> Owner/Autho ' -d •gent Signature Date (Revised 9/2014) <br />