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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 /> cj(- bo <br /> SITE ADDRESS: OPERTY TAX# P RMIT# <br /> l b '','L k3'' 41— 0641 29.00 4 O 200' 1 si 0 -o Lf 3 <br /> LEGAL for new construction: Short Plat/subdivision 3e,. Z(, -16 ,,)•;1j; l 7 t Lot No: . : ' r.(attach copy of long legal description) <br /> IL - Q� -p <br /> OWNER "ort C� De J Phone/E-mail 2.S 3 -- c.--)----) 1 ,(1 /l�b 0 <br /> Address 'k4(�R r),,,,,y), (wArt--- S0 , . City/State/Zip La e.L1..) D 6 t,A 1 �4i, v1 U 4 <br /> APPLICANT: Owner V Owner's Agent Contractor Contractor's Agent _Tenant(must provide a letter of consent from the owner to do work in the space) <br /> f <br /> CONTRACTOR -r'f,O Pa,tit c(d U t j (10 S--I State Lic.# City Bus. Lic.#'�?/ I <br /> Address Phone/Email ! Q / <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT . ?,(7 6-3 55 w Q�7L�{� <br /> \-+ A�.Y 5 A fou 146 Ki riN � 0 C,yz <br /> Phone/E-mail ahbos,C on, <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK C3 , v 0 0 <br /> Existing Use of Building(,'et; ;"--E2 0,rt )j 1.-</=•' .1-7A l/1 T gym' =;i )t). HEAT SOURCE: <br /> } <br /> Proposed Use of Building Nil()NS 5 6k C e '11.)e 11 Gas ✓ Electric Other <br /> Building type: Single Family Duplex Townhouse Mul -Family 'f Commercial <br /> Type of project: New Addition \V Remodel Repair T.I. Sign_Sprinkler Demolition Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> S p r.ce {ter-- o� to WI a S S a-U - e r1.�)h 6 , V is t 1/1- 7 (€' ,e, <br /> re iM�;�4A U+1 ►V i- g.ivt, SH bwF32 , SAL-WA (DPN <br /> Ps1Po t_vouCN sl.Uo ('A . <br /> MECHANICA PERMIT APPLICATION f 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 /> NC—air handling units Toilet j <br /> Forced air systems Bathtub <br /> Gas piping Lavatory(wastybasin) <br /> p�� Water heater i Shower ' <br /> V Gas fireplace 1 Kitchen ski'k&disposal <br /> Gas range - Dishwasher <br /> r Clothes dryer I Cloxltes washer <br /> Range hood Water heater <br /> ( Exhaust fan 'Sink(service/bar/mop/etc.) <br /> Heat pumpBackflow preventer(inside bldg) <br /> Unit heater p "tii`' Urinal <br /> Boiler r/ Drinking Fountain <br /> Refrigeration Floor drain <br /> • Woodstove Grease trap <br /> Ducting Roof drains <br /> Other Medical Gas <br /> �-' SPRINKLER / SUPPRESSION SYSTEM Other: <br /> "2/ Number of Heads 3 Other: <br /> I hereby certify that I have read and examined this application and know the same to be true and correct.At 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 I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> b 0" //)' '--) fl-'-\_: ' 2-(I' - I 5 <br /> Owner/Authoized Agent Signature Date (Revised 4/2015) 1 <br /> lz <br />