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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: 5 N 2-c,e PROPERTY TAX# ERMIT# <br /> O /f;-" S i;t«T GIJG`wt f (xi/4 eabac)O t, <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER 6c'/2t77 A)/:,/9 O tGOf l J`�j� Phone/E-mail 4Z 2 r B 4,1.E Z <br /> Address 3 (('7 cc)1.43q j✓t City/State/Zip £t/c le 049 q 2.o <br /> APPLICANT: Owner Owner's Agent _Contractor Contractor's Agent x Tenant(must provide a letter of consent from the owner to do work in the space) <br /> CONTRACTOR I'r h :rvr ' f .$` State Lic.# City Bus. Lic.# <br /> Address Phone/Email <br /> TENANT BUSINESS NAME O <br /> CONTAC FR PERMIT C� <br /> SI�Illl 6M x.3'1-� C�✓/-✓t"1' /Minc <br /> y u' x7Ay Jae z�`•1,ss0A-: r �� <br /> Phone/E-mail ttM 71O -e1,° rtL1IG�,Il le tv <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK Z� CO( ) <br /> Existing Use of Building /904/614 //- HEAT SOURCE: <br /> Proposed Use of Building _jig E Gas_ Electric! Other <br /> Building type: Single Family Duplex Townhouse X 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 /> AMAni 12 ,/t 913fe> 723 weft p02 Cc.N30L1,1177R✓4 QNr�'Wi'95" To <br /> zac/47,—/ ON gooF na atirretuf Yb6k -- Ori - po1 4 1r) <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT' APPLICATION ` <br /> 11ywdel-- <br /> Type of Project: New_Addn _Alteration Repair Type of Project: New Addn _Alteration_Repair f rid+ <br /> Show Number(#)of fixtures Show Number(#)of fixtures r l <br /> A/C—air handling units Toilet /.)f./ A <br /> Forced air systems Bathtub <br /> Gas piping Lavatory (wash basin) !riff • <br /> Water heater Shower <br /> Gas fireplace Kitchen sink&disposal <br /> Gas range Dishwasher <br /> Clothes dryer Clothes washer <br /> Range hood Water heater <br /> Exhaust fan Sink(service/bar/mop/etc.) <br /> Heat pump Backflow preventer(inside bldg) <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 /> 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 yob her specified herein or t 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 utho' ed the 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 /> Owner/Authorized Agent Signature Date (Revised 4/2015) <br /> 1 / L., <br />