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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: PROPERTY TAX# P # <br /> -3o(494.-"A ` SL• StECr- /_ ( "5503 .- 011- <br /> LEGAL for new construction: Short Piat/subdivlsiort� A ?$� O. P _tL- Lot No. (� 1 (attach copy of long legal description) <br /> OWNER 7j rr L PAG.•i .t L. roMt4 SGS Phone/E-mail C42' \CIS"? 2.50C) <br /> Address t2-0 S j it dct_ ..i� MPit,.A— t.A,vr•A City/State/Zip E ER -t r um. • ci132.1;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 /> CONTRACTORS'a.P V( SL ,AcG.+ -tC.. (40yyles State Lic.#ScATTp1•1Cv- 3 City Bus. Lic.#(•43-Z.4.41)40.0,34c <br /> Address 'j j .v'v jL Phone/Email 5e1/4tnn.i. <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT .31114 Ni C112,2,t,r;3zd <br /> Phone/E-mail (42-S\ 31'0 -- 4Qo Z_ <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of Building EAT SOURCE: <br /> Proposed Use of Building Gas to/-Electric Other <br /> Building type: ✓Single Family _Duplex Townhouse _Multi-Family _Commercial <br /> Type of project: 'New T Addition Remodel _Repair_T.I._Sign_Sprinkler Demolition Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> i klA '?k At i Z.C..A2 ce... E-. `RA z L *— RS - t4 Q 3 -- `oiz, td <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: KNew Addn _Alteration_Repair Type of Project: 4ew Addn _Alteration_Repair <br /> Show Number(#)of fixtures Show Number(#)of fixtures <br /> A/C-air handling units '3 Toilet <br /> 1 Forced air systems 2. Bathtub <br /> 4 Gas piping 4 Lavatory(wash basin) <br /> +a Water heater I Shower <br /> i Gas fireplace I Kitchen sink&disposal <br /> V Gas range 1 1 Dishwasher <br /> l I Clothes dryer t <br /> j Clothes washer <br /> I Range hood 1 1 Water heater <br /> LQ Exhaust fan t ( Sink(service/bar/mop/etc.) <br /> Heat pump Backflow preventer <br /> Unit heater Urinal <br /> ._ 1 Boiler Drinking Fountain <br /> 1 Refrigeration — Floor drain • <br /> Woodstove -- / Grease trap • <br /> Ducting LO Roof drains <br /> Other --- Medical Gas <br /> SPRINKLER/SUPPRESSION SYSTEM I Other: <br /> I Number of Heads I 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 taw regulating construction <br /> That I auth ed 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 298.200A WAC. ,(� <br /> tilt . -1 �'1 %"" ll <br /> Ow r/Authorized Agent ignature Date (Revised 3/2013) <br />