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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 /> SITE ADDRESS: PROPERTY TAX# PERM IT# <br /> I 3C-A6 Y CU-1 L Ave �v`�.3 y c 73k)ocD 106 � 1"� 11-00--T <br /> LEGAL for new construction: Short Plat/subdivision Lot No. <br /> j , (attach copy of long legal description) <br /> OWNER PL G r\ 1,�t� e� 1 t' c Phone/E-mail `—)L' p 7 k) o� �Jsy <br /> Address 71VlJ ^�/e� t( ? Dc& 5+ A. City/State/Zip /I �r1_- 1/�J A' ! (52.03 <br /> APPLICANT:_Owner _Owner's Agent Contractor _Contractor's Agent —Tenant(must provide a letter of consent from the owner to do work in the space) <br /> CONTRACTOR \'\c'( ) rt`i1 ( t 4i1._ (Q��>� Statea� Lic.c.wax( <br /> I Cld�1) `,.� � City Bus. Lic.# <br /> Address I(' �'^�(e9(jt�� UJCkv G 5.) F �' I /0 T Phone/Email ti <br /> TENANT BUSINESS NAME- / CONTACT F R PERMIT <br /> I3e 1 <br /> Phone/E-mail FOR 1 �S� -�U� �,J� Cts'\ <br /> S 06Ccco �/tet�.ya �-tc�r� C <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK 61(pCO 'CO <br /> Existing Use of Building kkHEAT SOURCE: <br /> t <br /> Proposed Use of Building I� I ' Gas/I Electric Other <br /> Building type: Single Family _Duplex_Townhouse _Multi-Family ,C Commercial <br /> Type of project: New Addition X Remodel Repair_T.I. Sign Sprinkler Demolition Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> tici-k1`1iocJ4\ t ✓\ L 154'vj g)7cUq_ <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New$_Addn Alteration_Repair Type of Project: New_Addn V Alteration_Repair <br /> Show Number(#)of fixtures Show Number(#)of fixtures <br /> A/C-air handling units I X Toilet <br /> Forced air systems Bathtub <br /> Gas piping I > Lavatory(wash basin) <br /> Water heater j Shower <br /> Gas fireplace Kitchen sink&disposal <br /> Gas range Dishwasher <br /> Clothes dryer Clothes washer <br /> Range hood Water heater <br /> Exhaust fan ; Sink(service/bar/mop/etc.) <br /> Heat pump I Backflow preventer <br /> Unit heater Urinal <br /> Boiler Drinking Fountain <br /> Refrigeration j Floor drain <br /> Woodstove I Grease trap <br /> Ducting j Roof drains <br /> Other Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM Other: <br /> Number of Heads i 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 I am authorized by the own 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 /> ) 0Z/ 1-3 <br /> Owner/Authorized Ag t Sign ure Date (Revised 3/2013) <br />