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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 /> SIT ADDRESS: • P� <br /> PROPERTY TAX# P RMIT# <br /> - GZ Nd 'sem. �J�e - 1504-DOG <br /> LEGAL for new construction: Short PlatisubdivisiorCA C.. O'.. ?A214- Lot No t (attach copy of long legal description) <br /> OWNER¶ Aitt t �AC.,f.-t,L. `400vt ta.S Phone/E-mail (42.5 <br /> Address 12..C. S Y...: i2 4rCc4-u-t% 11,-0\P.O.- L ,,Ar•-i City/State/Zip rte)Ekz-t S 2 4 <br /> APPLICANT: Owner _Owners Agent Contractor Contractor's Agent Tenant(must provide a letter of consent from the owner to do work in the space) <br /> CONTRACTOR. ..4...11-1....q."- ACa,rg__, 14,,A,A g S State Lic.#S cAtT Pt-►GC,S t3 City Bus. Lic.#t,c; -Z .- <br /> Address Sl�.,Akrc, Phone/Email SA.,rt _. <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> .111k4-fV Ci?aw=:��� <br /> Phone/E-mail 64Z5\ 3g.::,--t; ,- Li QC Z <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of Building 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 _Repair—T.1. Sign_Sprinkler_Demolition Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> . t (Ot'0 ?L41 -4 - (ZC-0162 ) 311/4-5k C. . 1q`O'-S -- Cflo <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 /> A/C-air handling units Toilet <br /> 1 i Forced air systems . ! Bathtub <br /> 4 Gas piping 4 Lavatory(wash basin) <br /> Water heater Shower <br /> t ; Gas fireplace 1 Kitchen sink&disposal <br /> 1 i Gas range 1 Dishwasher <br /> l Clothes dryer t Clothes washer <br /> i Range hood <br /> I_O I Exhaust fan 1 Sink(service/bar/mop/etc) <br /> Heat pump — Backflow preventer <br /> I Unit heater Urinal <br /> Boiler Drinking Fountain <br /> Refrigeration — Floor drain <br /> -- Woodstove -- Grease trap . <br /> -- Ducting CO Roof drains <br /> Other --- Medical Gas <br /> SPRINKLER /SUPPRESSION SYSTEM Other: <br /> I 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 complied <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 anti auth zed by the owner of this properly to perform the work for which application is made and I comply with the State Contractors Law 18.27 RC'N and 296 200A WAC. <br /> ..,46 <br /> Owr/Authorized Agent ignature Date (Revised 3/2013) <br />