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F <br /> t <br /> 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 /> [ Z0G-I tt -Woe) <br /> SITE ADDRESS:301 l7• `'7-6- S%-,-3 PIS KRTYTAX# P RMIT# <br /> �v-e....•./c.�? W e ` 2(:-)I I�f33— <br /> LEGAL for new construction: ShoPlat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER JO`tlVl ms <br /> V, {�•••-,V''Oil-e Phone/E-mail Iiwl L 1 , Y� <br /> Address 857 i 841 V , E 1y/State/Zip 5Qc5 <br /> 1 t L `&J ?i3 I irS <br /> APPLICANT:_Owner _Owner's Agent ntractor _Contractor's Agent1_Tenant(must provide` 4a loner of corms from the owner to do week in the space) <br /> CONTRACTOR-)C��VtOc�SOV1 �\ ‘'-'1491'-'1491 #J <br /> 6.0 State Lic. 0\1\ISR(T)6V D City Bus.Lic.#054/C <br /> Address Z(33 N,1). '2...09 43-Si).. s\lo ik� to„, Phone/Email�A6)313-57 7-3 �0.Y2�Javt h <br /> TENANT BUSINESS NAME CONTACT F R�/ <br /> PERMIT°r:\( p �ir I( if <br /> PnonelE-mail,-2 5 14i 11‘00 J rr C I)'}I.t.- �0 r (+?,t^ <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK I I13, Su� <br /> no•` CO', <br /> Existing Use of Buildingt---e3-L <br /> t. HEAT SOURCE: <br /> Proposed Use of Building Gas Electric Other <br /> Building type: _Single Family Duplex Townhouse ulti-Family _Commercial <br /> Type of project: _New Addition _Remodel epair T.I. Sign Sprinkler Demolition Change Use \ <br /> DESCRIP ION OF WORK(additional space provided on the back)' ) <br /> .L-c �\ U s Co�;k \ pg.., dti � v� I(INA-Lk�'C�\-(1 who a st "u ti <br /> s4.,,9 s w \I e...•-1 5 4 .�, 4s4.t,i.55. <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 /> NC—air handling units Toilet <br /> Forced air systems Bathtub <br /> Gas piping Lavatory(wash basin) <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 <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 a•. •know the same to be true and correct Al provisions of laws and ordinances governing this type of work wit be comp <br /> '. -,er specified he or not The• . f a•- - - not presume to give authority to violate or cancel the provision of any other state or local law regulating construction <br /> That': by e• , 4, work for which application is made and I comply with the State Contractors Law 1827 RCW and 296200A WAC. <br /> =dAuthorized Agent Siatu Date (Revised 9/2014) r <br /> I Z <br /> Ce <br />