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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 8511 9 Ave ;Tr 1Z Zap/ Pl/ll T"eJ1t fl)OOt OOO I PE7 o —01 I <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER (p 1 K Ne!s��+ p Phone/E-mail Ctc.rK— Nelsoi -G-opa'Fier`- Coll <br /> Address L S 221" Ave. S- iz Los City/State/Zip Eve re If / <br /> VA L LUG' <br /> APPLICANT:A 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 A,.1 e..- j riS f i„t.,1;o„ State Lic.# 0`F/V C-* I D Id l3 City Bus. Lic.# is 7 <br /> Address i 9 1,1 Te cr c,,ce Id. Shohom.iSti l 5L no Phone/Email 360 - 5 bS -g i/4.Z.- <br /> TENANT <br /> TENANT BUSINESS NAME cONTACT FOR PERMIT <br /> Dawn (le[s i- a355—q31 1 <br /> Phone/E-mail <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK 55/000 <br /> Existing Use of Building Re s-i de..4-4,1 HEAT SOURCE: <br /> Proposed Use of Building RC Slim'♦.',.1 Gas Electric)( Other <br /> Building type: k Single Family _Duplex_Townhouse _Multi-Family _Commercial <br /> Type of project: New )G_Addition Remodel Repair T.I. Sign_Sprinkler Demolition Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> 32'7 5)-* Meal er Bed ci- Be,-16 cid.-1.0•• % <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: New Addn _Alteration_Repair Type of Project: New Addn _Alteration_Repair <br /> Show Number(#)of fixtures Show Number(#)of fixtures <br /> i NC—air handling units Toilet <br /> Forced air systems � Bathtub <br /> Gas piping Lavatory(wash basin) <br /> Water heater I Shower <br /> Gas fireplace Kitchen sink&disposal <br /> Gas range Dishwasher <br /> Clothes dryer Clothes washer <br /> Range hood Water heater <br /> I Exhaust fan Sink(service/bar/mop/etc.) <br /> Heat pump Backflow preventer <br /> Unit heater Urinal <br /> Boiler Drinking Fountain <br /> Refrigeration Floor drain <br /> Woodstove Grease trap <br /> Ducting 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 Imowthe 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 /> Tha I am authorized 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 296.200A WAC. <br /> a i ' ZO - ZO! \(Z <br /> Owner/Authorized Agent Signature Date (Revised 9/2014) <br /> I <br />