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A° <br /> PERMIT APPLICATIO <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:. (C efa PROPERTY TAX# # <br /> 1302 Broadwal lgs20 0�52� oy I t I 022 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER�I—E\ev'� \`t C #i1—{y_3.s3 Phone/E-mail <br /> AddressHo° C,Qtle'ia. et<wy st si-Q. 15OD City/State/Zip c 1CX CL l GF 3039 <br /> APPLICANT:_Owner _Owner's Agent X Contractor _Contractor's Agent _Tenant(must provide a letter of consent from the owner to do work in the space) <br /> CONTRACTOR VY Om.v(1 9...00k\ B Irl lct. In L• State Lic.# KRNY--P-V:C -+C2City Bus.Lic.#0598l6 <br /> 3 <br /> Address P to, Box 3 l I 13 P CSI 1op boa "[1'8'313 Phone/Email 25'3-110- 5950 <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> 1COY <br /> 1 �jA t,�oo.U e_ <br /> t .- rCy V �n Phone/E-mail 2I <br /> �J" `'l®_ -l31 1 VLo \J <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK t.6kS2 5$p .00 <br /> Existing Use of Building C—It i ' ` R . 0 \ 1 HEAT SOURCE: <br /> Proposed Use of Building S Sa i Gas_ Electric Other <br /> Building type: _Single Family _Duplex_Townhouse _Multi-Family X Commercial <br /> Type of project: _New _Addition _Remodel _Repair X T.I._Sign_Sprinkler Demolition Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> PS2VC\OPel ex1 �C-ir ' voo- -i n S S-��m ,i r\st-a.\\ r evil s —ern <br /> 'enspacr - - r'e?r Dov o- Q�-� s I n t e. - 1( rOO-� S� <br /> me- —o,1 CO i r S • g <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 /> 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(inside bldg) <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 application and know the same to be true and correct.All provisions of laws and ordinances governing this type of work will be comp <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 au ori y 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 296.200A WAC. <br /> ner/Authorized Agent Signature Date (Revised 4/2015) <br />