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r <br /> • • <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: 3 5 6 01 id old A PROPERTY TAX# P E.RIVIIIT# <br /> LEGAL for new construction: Short/Plat/subdivision Lot No..- (attach copy of long legal description) f <br /> OWNER -ZEE VV Q((1; Phone/E-mail `12-5 �'V 7311 4• IEem,1KtriN 1@ t�./s6-7) •Cdr <br /> Address 4+%,60 ! _ O OX 3 g( /?1 �•,o i r,- ity/State/Zip j��& ,1 O VV 4 t ss o V-3 <br /> APPLICANT: X owner _Owner'sAgent _Contractor _Contractor'sAgent Tenant(must provide a letter of consent from the owner to do work in the space) <br /> CONTRACTOR/ G t/U 1(t_(' _State Lic.# City Bus. Lic.# <br /> Address Phone/Email <br /> TENANT BUSINESS NAME CONTACT FOR PERMITr" 25-.7 <br /> Phone/E-mail ilZe E Il,t,K-f m )ism, (n t, <br /> T 1 <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of Building Sp�r��' j� HEAT SOURCE: <br /> Proposed Use of Building 1`-031( /� t� Gas Electric Other_ <br /> Building type: xSingle Family Duplex_Townhouse _Multi-Family _Commercial r l/ <br /> Type of project: —NewAddition _Remodel _Repair_T.I._Sign Sprinkler_Demolition_Change of Use <br /> DESCRIPTION OF WdRK(additional space provided on the back): <br /> A140(11° a- 66k0-0l1 O i2- ©a rv► -0 r-ea e__ 0 C <br /> kows-e , 4 <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 air systems Bathtub <br /> Gas piping Lavatory(wash basin) <br /> Water heater Y7 Shower <br /> Gas fireplace /" I Kitchen sink&disposal <br /> Gas range Dishwasher <br /> Clothes dryer j Clothes washer <br /> Range hood Water heater <br /> Exhaust fan Sink(service/bar/mop/etc.) <br /> Heat pump I Backflow preventer <br /> f Unit heater j Urinal <br /> Boiler I Drinking Fountain <br /> Refrigeration Floor drain <br /> Woodstove Grease trap • <br /> Ducting h Roof drains <br /> Other ' i Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM Other: <br /> INumber of Heads j 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 lam authorize. .y the ow - o ,'s 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. 2 <br /> -4.0r '\ / / €A,\ <br /> 21j Zoe `12- <br /> Owner/Authorized Agent Signature Date (Revised 3/2013) <br />