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Jan. 21. 2016 9:47AM No. 1664 P. 4 <br /> PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett,WA 98201 425-257-8890 FAX 425-257-8857 www.everettwa.org <br /> SITE ADDRESS:ESS: } pit4p�ftTY TAX QVj=,13,�1j �I��� <br /> <';'?)I A •V f:..6Y )"'i V t;y 0 t ere f;?(.r% :F C E1� 1 t/U ii <br /> LEGAL for new construction: Short Plat/subdivision• Lot No. • (attach copy of long legal description) <br /> OWNER r l( (Gti. <°,,g' phone/Li-mail if) .".a 1 c;;;;:?)(:) I <br /> Address L 1} .A1310:6 l S/[•t Clty/State/Glp f�/L'rhd t- 1:L.okr <br /> APPLICANT:_,Owner Owner's Agent 4 Contractor _. .Contractor's Agent _Tenant GtmaturovI0ee!altar monnarntCom too ovncr10duc rskthe apace) <br /> j _� l.:F't'•;<.::s State Lia# (.'S is F t=r r.':'`r�F:30i::.:. ...City Bus.Lic.#C; <br /> CONTRACTOR ''//••(•' °•�}-� <br /> Address ?)l £)' .'k::: I.L.J',ti±" ✓}x ., Pttono/Lmall c•i:)y;'.,..,...- .dw sl.......C,/ � �� �x <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Phone/E-mail L;f..-, ......is c'.... <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK b , <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building Gas ,.-._.. Electric Other <br /> Building type: _Single Family _Duplex_Townhouso _Multi-Family _Commercial <br /> Type of project: Now Addition Remodel _Repair T.I._ ,Sign_Sprinkler Demolition,..__Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> Y\e4VILe- (() <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Typo of Project! _New_Arian Alteration_Repair Type of Project: New Afidll _Alteration_Repair <br /> Show Number(II)of fixtures S/row Number(ft)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/eta) <br /> Heat pump Backflow preventer <br /> Unit heater Urinal <br /> Boiler Drinking Fountain <br /> Refrigeration Floor drain <br /> Waodstove Grease trap <br /> Meting Roof drains <br /> Other Medical Gas <br /> SPRINKLER/SUPPRESSION SYSTEM Other: <br /> Number of I-leads Other: <br /> I horoby eerliry that I have read and examined this application and know tho smoke to be hue and corroct All provi:aorw of laws and ordinances governing this type of won(will be comr+l <br /> with whether specified heroin or not The granting of a permit doe;:not presume to give authority to violate of Ocnoal the provision of any other Ante or local law regulating constrectiurr <br /> That I am auth zed by the owner or this property to perform the work forwhIch°polic:licm is made and r comply with the St:dc:Contractor's Law 18.2?f1GW and 298.200A WAC. <br /> i/Z. /4.7 <br /> OwnorlAuthorizedAgent Signature Date (Rovfsed 0/2019) <br />