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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: 340 1 •;wujika � DIV <br /> �`, IPVR,�Q/vP�RT�' A�# (��C �G� P MIT O / C ? <br /> LEGAL for new construction: Short Plat/subdivision \i�Vf,bt I V H 8.330 Lot No44 1� (attach copy of long legal description) <br /> OWNER Llt�t�� G�UUGt \ �9 ( Phone/E-mail2–��/�/�� <br /> Address '�'�fj 1 T�{HCl(l j+�/c?- City/State/Zip t �/1 /Tl zo I <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 ()LOA.A/`�+- Q'� State Lic.# /' ^ �/ City <br /> K,Bus. Licc..#r <br /> Address 34�)1 (,(I(.�It ' IVG� - �/ G� �� Phone/Email `1���"_`I�0' ��c.` � wl1 <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> 5ank,k <br /> Phone/E-mail V(LY <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of Building al CA f k-- HEAT SOURCE: <br /> �Proposed Use of Buildingk 5,,dy ck— Gas Electric-C Other <br /> Building type: XSingle Family _Duplex_Townhouse _Multi-Family _Commercial <br /> Type of project: _New Addition _Remodel Repair_T.1._Sign' •'_Sprinkler Demolition _Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): IVK.o►w)t 60 r&Llt�141 i6t4l , �V-Jk-- *`5Zi.UIIS <br /> U>tii t xt v Fi(CLct; iCt&L Scmu­a U pt tt uv(Jc r l lc>h,z-/v- YIR QGI �La Utc�l Lk, <br /> U)ti's Y111.w Ct,�\d !�5 ko Lj Celt ws t nx n"\ � ; cx t dec lc- t G f z t i Cs <br /> L'GY.t, . J c L/- t-1'ltiG�,e v d Pc(� l�r �vF n. t- n e t'►�� vri c r <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 /> 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&di sal <br /> Gas range Dishwasher <br /> Clothes dr,e( Clothes w er <br /> Range od Water ater <br /> Exh ydst fan Sink service/bar/mop/etc.) <br /> H `t pump B ckflow preventer <br /> nit heater I /Urinal <br /> Boiler j Drinking Fountain <br /> Refrigeration Floor drain <br /> Woodstove Grease trap <br /> Ducting Roof drains <br /> Other I Medical Gas <br /> PRINKLER / SUPPRESSION SYSTEM 7 Other: <br /> �- I 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 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 a 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 /> Owner Authorized Agent Signature Date (Revised 3/2013) <br />