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• 0 <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 ADDRESS: _ PROPERTY TAX# P MIT# <br /> ir10_'E . i h A �a� J„ !:O SgL-12(5Oy0C)2(00 1 ?)g - V <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER L v) n{ r )e-�f cnc,,irck`n�eV Phone/E-mail <br /> Address I tS�0 E . 1�eG{'r.tv wpJ i ^(✓J{rt tr fu AC1'82 0 3 City/State/Zip <br /> APPLICANT: �, Owner Owner's Agent —Contractor _Contractor's Agent _Tenant(must provide a letter of consent from the owner to do work in the space) <br /> CONTRACTOR C US t G M lA 6 nnf 5 QW State Lic. # City Bus. Lie.# <br /> Address lett; k; 0 Q�-v tl,.t y k.jPhone/Email q 2 1(.p J -1 <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> 3,t'� F C—t�vd.1^e►- `125-� c�o-��7z <br /> Phone/E-mail Y zjctq-Ck er C yc,l�pt� <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building..LBO, C­a(adS Gas Electric)L Other <br /> Building type: '� Single Family _Duplex_Townhouse _Multi-Family _Commercial <br /> Type of project: New _X_Addition Remodel Repair_T.I._Sign_Sprinkler_Demolition Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): $0ti0s <br /> Aic� t g � C- Sp�Ce oar, t-o� 0� R,:t•M <br /> � � Pct Q rG e w t fin :L..t� <br /> cJG`va�e tD be tt�tcv.P�t ) C-\t ho w w b��tztwacJ . <br /> MA -LJc?R 13 oti LIS eoDti 3 03 S4e u fio6iz r-L-oJvz = -7Z,---, Sr 117 rl' <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 j Toilet <br /> Forced air systems Bathtub <br /> Gas piping j Lavatory(wash basin) <br /> Water heater j Shower <br /> Gas fireplace i Kitchen sink&dispo <br /> Gas range Dishwasher <br /> Clothes dry Clothes wash <br /> Range hodd Water heit6i <br /> I Exhau fan Sink(s ice/bar/mop/etc.) <br /> He pump Ba low preventer <br /> it heater Xrinal <br /> Boiler Drinking Fountain <br /> Refrigeration Floor drain <br /> Woodstove Grease trap <br /> Ducting Roof drains <br /> Other Medical Gas <br /> PRINKLER / SUPPRESSION SYSTEM i Other: <br /> Number of Heads Y, 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 am authorized 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 RC W and 296.200A WAC. <br /> -P, Gap�� S 176111-2-, <br /> Owner/Authorized Agent Signature Date (Revised 3/2013) <br />