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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 vvvvvv.everetwa,o19 <br /> y vSI\- ti Ll <br /> • <br /> SITE ADDRESS: ,.., .PROPERTY TAX# ,, PERMIT# a 1 511 _0(0 <br /> V. 130 <br /> e,V 4 • C'e ey\ <br /> LEGAL for new construction: Short Platisubdivision Lot No. (attach copy of long legal description) <br /> OWNER Oct,V4-4-1:k j\e-- Phone/E-rna <br /> Address City/State/Zic <br /> APPLICANT: .Owner _,.._Owner's Agent ) Contractor Contractor's Agent ___Tenant ritu$1 pfovioe a':eZter 01 0On03,11 IMITI the owne to or;'00'S, she space) <br /> CONTRACTOR ScweiAo merilqvi t`cct I State Lic.#6o3 0S9 CAS City Bus.Lic.# <br /> Acdress 4:6'2°0 CA) 1>eraC_ Vi—e5 Aki e.... ke_049 ,),t1r, (4Pt Phone/Email 5*9-55(-3 3 0 R/.50,'.,4701 eck(ipc.rivtur t.conot <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT sk,,,e5 euctico tA" <br /> tov .4-6t J yk.C_ phoneiE_rnan <br /> BUILDING PERMIT APPLICATION IcONTRACT PRICE OF WORK <br /> . < <br /> Existing Use of Building Ock.vt:4-ct D("edit ...5 .• <br /> • <br /> • <br /> HEAT SOURCE: <br /> Proposed Use of Building 01.V 4 tt t>,-(4 y 515 i Gas Electric Other <br /> Building type: .Single Family Duplex_Townhouse Multi-Family 1,......,. Commercial <br /> ripe of project: New Addition lc Remodel Repair T.I. Sign Sprinkler Demolition Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): R.e,viodi.e 04. A.C 42 1.-i it C..--( VC-- 1..(:) <br /> Ck aa 5k2 A - ..ke<P1 et(t"*.45- gtwtovt. ota- 'ti;10.44.0‘ri cc CAP: <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: New Addn _Alteration Repair Type of Project: New i. Addn KAlteration Repair <br /> Show Number(b)of fixtures Show NuMber(Not fixtures <br /> A/C—air handling unitsl Toilet <br /> . . <br /> Forced air systems .Bathtub <br /> Gas piping 4 i Lavatory(wash basin) <br /> Shower <br /> Water heater l <br /> Gas fireplace sink&disposal <br /> . . , <br /> Gas range I Dishwasher <br /> Clothes dryer .Clothes washer <br /> , . <br /> Range hood I Water heater <br /> Exhaust fan Z I Sink(service/bar/mop/etc.) <br /> Heat pump l Backflow preventer(inside bldg) <br /> Unit heater . I Urinal <br /> ' Boiler i l Drinking Fountain <br /> Refrigeration 3 : Floor drain <br /> . I - <br /> Woodstove : l Grease trap <br /> Ducting ! l Roof drains <br /> Other <br /> Medical Gas <br /> ........--; <br /> SPRINKLER/ SUPPRESSION SYSTEMI Other: <br /> Number of Heads I l i Other: <br /> I hereby certify that I have read and examined this'appiication and 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 specified herein or not.The granting of a permit does not presume to give authority to violate or cancel the pipvision 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 appiioation is made and I comply with the State Contractors Law 18.27 RCW and 296,200A WAC. <br /> q--00Pi ii"IP /5 . <br /> • <br /> Owner//thorized Agent Signature Date09 (Revised 4/2015) <br />