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0 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: f� PROPERTY TAX# P MIT# <br /> 170( br� . Ave, Doi{ z35ioZKvG " & <br /> LEGAL for new construction: Short Plat/subdivision 1:1Lfel Q.J u P4.'T ftk! t No.Z`f rPattach copy of long legal description) <br /> OWNER Mq 5C, % Phone/E-mail <br /> Address (, J So,4t) Zo f O t�,) city/state/zip '5f;�n uk J IWAI q q Z`1 Z <br /> APPLICANT:_Owner _Owner's Agent _Contractor _Contractor's Agent Tenant(must provide�a letter of coonnsent from the owner to do work in the space) <br /> CONTRACTOR G ee-. C�nG( oix+d�Y Statue Lic.e# 6(-Gs,�C0 +Clyy us. Lic.#OLM So <br /> Address 3 bo 1 � v' Su, 4A1C,. W At .-(6(,3"t Phone/Ema � "'[•7 4 -WOO <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> �`} ,�(� We t7�� <br /> , (0.,&-- <br /> Ole -mail CLo�f'1CCXonu� �£'rC9^�T��iG`��GM <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building Gas Electric Other <br /> Building type: _Single Family _Duplex_Townhouse _Multi-Family —Commercial <br /> T e of roiect: New Addition Remodel Repair T.I. Sin Sprinkler ADemolition Chane of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): l <br /> - Rt-���'..� `�;i(6aa�- ���f,�•,F^� ��t�,�+ ��' OU=�''cs 5 ���eb'�T <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 airs stems 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 <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 a d 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 cified herein or not.The granting of a per ' es not presume to give authority to violate or cancel the provision of any other state or local law regulating construction <br /> That I am 'homed by the owner oft rope o e work forwhich application is made and I comply with the Slate Contractors Law 18.27 RCW and 296.200A WAC. <br /> Owner/Authorized Agent S' nature Date (Revised 9/2014) <br />