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PERMIT <br />0 <br />• <br />APPLICATION <br />BUILDING/MECHANICAL/PLUMBI NG/SIG N/SPRIN KLER/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: <br />J2G '�ret�-ion Places <br />PROPERTY TAX # <br />M-1.1103 5 <br />P RMIT # <br />Q- - <br />LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br />OWNER ]PoLtCdO-+C�y�, ttN 1Q Ch,� �(�► Z'P <br />Phone/E-mail 1 <br />Address Vuy- T l ate - S t,�.i� . C <br />City/State/Zip lot t Y -)q-301 -k+ <br />APPLICANT: _ _ Owner's Agent Contractor —contractor's Agent _Tenant (must prov de a letter of consent from the owner to do work in the space) <br />^Owwnner <br />CONTRACTOR t '�j Q L��'_C6K— <br />State Lic. # iii rlQ�� P� City Bus. Lic. # <br />AddressQ�[�c ff(tC�Q qJJJ f <br />Phone/Email e, ° t <br />TENANT BUSINESS NAME <br />CONTACT FOR PERMIT <br />heo k,0 OLt Y ,q <br />Phone/E-mail 2-`j aCj2 Ci CP <br />BUILDING PERMIT APPLICATION <br />CONTRACT PRICE OF WORK q(;�7&00— <br />Existing Use of Building HEAT SOURCE: <br />Proposed Use of Building Gas Electric Other <br />Building type: J Single Family _ Duplex _Townhouse _ Multi -Family _ Commercial <br />Type ofproject: New Addition V"' Remodel Repair T. 1. Sin _Sprinkler Demolition Chane of Use <br />DESCRIPTION O(F�WORK (additional space provided on the back): Y:by c *0 ma -k -Q— +U -Q-- <br />plemov-e hd(� V11a(I r r2nnOLl�j b <br />MECHANICAL PERMIT APPLICATION <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteration _Repair <br />Show Number #) of fixtures <br />Type of Project: _New _Addn _Alteration _Repair <br />Show Number(#) of fixtures <br />A/C — air handling units <br />Toilet <br />Forced airs stems <br />Bathtub <br />Gas piping <br />Lavatory wash basin <br />Water heater <br />Shower <br />Gas fireplace <br />Kitchen sink & disposal <br />Gas range <br />Dishwasher <br />Clothes dryer <br />Clothes washer <br />Ran a hood <br />Water heater <br />Exhaust fan <br />Sink (service/bar/mop/etc.) <br />Heat pump <br />Backflow preventer inside b1d <br />Unit heater <br />Urinal <br />Boiler <br />Drinking Fountain <br />Refrigeration <br />Floor drain <br />Woodstove <br />Grease trap <br />Ducting <br />Roof drains <br />Other <br />Medical Gas <br />SPRINKLER / SUPPRESSION SYSTEM <br />Other: <br />Number of Heads <br />Other: <br />I hereby certify that I have read and examined this application and know the same to be true and correct. AN provisions of laws and ordinances governing this type of work will be comp <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 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />'la a � ��aj 0 - IL-L� .)1XA` Y <br />Owner/Aut riz Agen ignatu Date (Revised 4/2015) <br />