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(5700/- ScO • CuerrilrAA• <br /> aryette <br /> PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett,WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br /> SITE AOPRESS: PROPERTY TAX# P,.E�RMI <br /> � ; E erC;#_ '// -2S70,:57 2O ('1/06 .V Y RNMI t 1- <br /> LEGAL for new construction: Short Plat/subdivision� Lot No. (attach copy of long legal description) <br /> OWNER 70, <br /> {47 ¢`` - T -03-Y?C-03-Y? Phone/E-mail (MO"" j - C - <br /> �- <br /> +� <br /> AddressstO >< c1�7 S:`.e (1,1-f.d 0 4 c,001 i\, AI cS'11O City/State/Zip p))Cyt of�R 3(! t`:5 rA4 `1 <br /> APPLICANT: Owner _Owner's Agent Contractor Contractor's Agent _-Tenant(must provide a tetter of consent from the owner to do work in the space) <br /> CONTRACTOR <br /> ���, ()LAINCe_ �^/1't i:5ercct is 'l 5tHtme,,_ State Lic.#50U{U# t�cl S PE / CityomBus.Lie.#( 94 /I <br /> Address J t2 t' /�(/J'7C� i/tC•r7 4 /� j Zl^t�jlrti(G�Sc1/Ctt� Phone/Email 51) <br /> J/ )QR'70 1 e serdt-1- .CGigii <br /> TENANT BUSINESS NAME / CONTACT FOR PERMIT✓✓fe • (' o ktzt <br /> e., Phone/E-mail 3 7V-77(10 <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK 3(e/ oc O <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building Gas_ Electric_ Other <br /> Building type: _Single Family Duplex Townhouse _Multi-Family 1-""Commercial <br /> Type of project: New Addition Remodel Repair T.I. Sign Sprinkler Demolition Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> t o s4Fit( 1,114R i s e rrt / j Mc,3 0/1 ;y/isN412: G eSe f l rwog Cot <br /> *ti- ect Cctl Olt 7 /`— 7 7S-0-40 (t Y p-ervoi+-,ge 44)7 C rY- cat r` ' <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: E/New Alteration Repair Type of Project: New _Addn _Alteration_Repair <br /> Show Number(#)of fixtures Show Number(#)of fixtures <br /> I 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 1 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 compi <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 a r -uthorriizedby the owner of this property to perform the work for which application Ls made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> / Ct <br /> Own•rAuthorized Agent Signature Date (Revised 4/2015) <br /> 1 <br />