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PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINT'CLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everet[wa.org <br /> SITE ADDRESS: PROPERTY TAX# PERMIT# <br /> r4 S T- 5 e ()000 x;'4,0© <br /> LEGAL for new construction: Short Platisubdivision tq ttr'► !e: Lot No. <br /> �f! (attach copy of long legal description) <br /> OWNER eco. YG C I C7�'1�++ `> Phone/E-maitV, '5-c rj3-a 87001W 14,tW,5&t c,�0M-(5 CO <br /> Address O 5\4/ E tfeedk Met 1` Wft I Stx,�c LW City/State/Zip EUr fc`A lk.ei, � �a 0 <br /> APPLICANT: Owner _Owner's Agent _Contractor Contractor's Agent _Tenant(must provide a letter or consent from the owner to do work in the space) <br /> CONTRACTOR 5��, Qat L eyy5 �! State Lic.#_ !��?t�Z�'{�� 0 05 0� City Bus.Lic.# � J <br /> Address �O5w up, m--h We -c,,,,4.- 102 �cJGcrl W,q PhonelEPa; `l.�r3�SOG d/,bea •.c ' <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> 0M Ao5ei kx-, , <br /> Phone/E-mail x-31 S- `1f3C�/(y'K.�"IT.I/��5�.:. tcrk7/v1r5.�c1�d <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 /> 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 /> Vic) <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Protect: , New_Addn _Alteration_Repair Type of Project: _New_Addn _Alteration_Repair <br /> Show Number(#)of rrxtures Show Number(#)of fixtures <br /> A/C—air handling units Toilet <br /> Forced air systems Bathtub <br /> Gas piping I Lavatory(wash basin) <br /> Water heater j Shower <br /> f Gas fireplace Kitchen sink&disposal <br /> 1 ; Gas range Dishwasher <br /> Clothes dryer / j Clothes washer <br /> tt Range hood <br /> C Exhaust fan ; Sink(servicelbar/mop/etc.) <br /> ( Heat pump f Backflow preventer <br /> Unit heater 1 Urinal <br /> Boiler Drinking Fountain <br /> j Refrigeration ( Floor drain <br /> Woodstove Grease trap <br /> Ducting ; Roof drains <br /> Other ! Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM j 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 taws and ordinances governing this type or work will be complied <br /> with whether specifled herein or not.The granting or a permit does not presume to give authority to violate or cancel the provision of any other state or local layr 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 16.27 RCW and 296.200A WAC. <br /> 4�0 �)-- 3 --/sL 2 <br /> Owner/Authorized Agent Signature Date (Revised 3/2093) <br />