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Jul 14 2015 8: 25AM West Seattle Furnace 208 935-0735 p . 2 <br /> PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St, Everett, WA 96201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br /> SITE ADD PROPERTY TAX t3 PERMIT# \ <br /> ��6 18- .S _ DI 34 6•0 o -t- ) y��, I AL1- c2 <br /> LEGAL for new construction: Short Ptatlsubdivbsion Lot No. (attach copy of long legal description) <br /> OWNER V al -L-1\ W C��` L Phono/E-maid - 5 ) . �a <br /> Address � L Q City/State/Zip <br /> APPLICANT:_Owner Owner's Agent XContractor _Contractors Agent —Tenant tmust pn:vide ailter-et consult from the owner to do work in the space) <br /> CONTRACTOR ( a j State LiC.# JIL--j K-Cl Ci Bus. Lie. # <br /> d gg Q 0 <br /> AddresstO 01 5 t- 1-C- "4 6 48 Phone/Email •0 L - -140(2) <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT Ct 1 m%4._ Cap /I-- - <br /> Phone/E.-mai CLA m1-Leb +i'1l�A CSO <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK c) <br /> Existing Use of Building _ HEAT SOURCE: <br /> Proposed Use of Building GasY Electric other <br /> Building type: X2iingle Farnay Duplex Townhouse Muttl-Family Commercial <br /> Type of project New Addition Remodel Repair OT.i._Sign Sprinkler_Demolition Chance of Use <br /> DESCRI TION OF WORK(additional space vided on the back): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: New Addn l iteration_Repair Type of Project New_Addn Alteratiowt Repair <br /> Show Number(#)of furfures Show Number(#)of fixtures <br /> NC–air handlin. 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 i Clothes washer <br /> Range hood i Water heater <br /> Exhaust fan Sink(service/bar/mopfetc.) <br /> Heat pump Backflow presenter <br /> Unit heater Urinal <br /> Boiler i Drinkin• Fountain <br /> Refrigeration Floor drain <br /> W oodstove Grease tra <br /> Ducting Roof drains <br /> Other I Medical Gas <br /> SPRINKLER I SUPPRESSION SYSTEM Other <br /> Number of Heads Other <br /> hereby certify that 1 have read and examined this apelce/ion and know the same to be true and correct_A!provisions of laws and ordinances novoming this type of work wAl be comp <br /> h,.4- ther no-noires:3 heroin er not The g.enting d e perrnit doe.not h ph,authority to riolatte or the pro,.-Dion of arty oeter elute or k>of 6r ro- Writing ceneSuetton <br /> Th. tam author rod try the of this property to perform the work for whin pitcation is erode and I cwniAy with the State Contractors Law 1827 ROW and 296.208A WAC. <br /> (4) 1C1:5 ( <br /> r/Autherasd Agent Signature Date <br /> (Revised 9r1G14) <br />