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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: _ IIMI. p•OPERriTAXI/ <br /> RMIT# <br /> l, r • (� n j <br /> IM (2 <br /> LEGAL for new construction: Short Plat/subdivision <br /> Lot No. (attach copy of long legal description) <br /> OWNER 11" l '. \ C-- 4 t ,l ri Phone/E-mail 6 • c Li / <br /> Address City/State/Zip <br /> APPLICANT:_Owner Owner's AgentContractor Contractor's Agent Tenant errant(must provide a letter of consent Rprn 1110 owner to do work In the apace) <br /> CONTRACTOR 'Br l.,y ,, State Lie,# �j /� /� n�3 <br /> 1' { `?Woo <br /> 1gi L�-`�1nCityy�Bus. Lic.#d Q 1g pf .• 0 <br /> Address L 01 - 4 . I� ` •Of L 7g • �t_ : PhonefEmailTEN•NT BUS `ESS NA f E CONTACT FOR PERMITYh 1•L CZ-125—.A.4.•\"4-1(.1 <br /> -- --..,r— Phone/E-mail f Y'Y'i-Lt II, `, •. k y . tY <br /> ,py1 <br /> BUILDING PERMIT APPLICATION '?CONTRACT PRICE OF WORK ' 1 g $i <br /> Existing Use of Building _ NEAT SOURCE: <br /> Proposed Use of Buildi Gas Electric Other <br /> — <br /> Building type: 1./ iFamily _Duplex Townhouse _Multi t ily _Commercial m <br /> Type of project: New Addition Remodel Repair VT.I. Si=n S.rinkier Demolition Change of Use <br /> U CRIPTit3N OF WORK{eddltlo t space provided on the eek); <br /> l . c..9 -c- `dam 6k-e� s w 0.- C-t- �w (.0 C� a s 1 �` pi <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project! New Addn ration Repair Type of Project: New Addn Alteration Repair <br /> Show Number(#)of fixtures . Show Number(#)of fiXtures <br /> i NC-air handling units Toilet <br /> Forced air systems Bathtub <br /> I Gas piping Lavatory(wash basin) <br /> Water heater Shower <br /> - <br /> Gas fireplace Kitchen sink&disposal <br /> Gas range <br /> Dishwasher <br /> Clothes dryer Clothes washer <br /> Range hood Water heater <br /> Exhaust fan ^' Sink(service/bar/mop/etc.) <br /> Heat pump Backflow preventer <br /> Unit heater Urinal <br /> Boiler Drinking Fountain <br /> Refrigeration <br /> Floor drain <br /> We,odstove _ Grease trap <br /> Ducting Roof drains <br /> Other Medical Gas <br /> SPRINKLER/ SUPPRESSION SYSTEM Other: <br /> 1 Number of Heads 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 lawa and ordinances governing this type of work will be comp <br /> whether specified herein or not.The granting of a permit does not presume .give authority to violate or cancel the provision of any other state or local law regulating construction <br /> I am authorized by the own:r of thia property to perform the work .r which.pplioation is made and I comply with the State Contrectora Law 18.27 RCW and 255.200A WAC. <br /> Al_ A .•11 . At<L 5 J(/ I c, <br /> O ner/Ruth•rued Agent Signature Date <br /> (Revised 9/2074) <br />