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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:9./04 , �n1 /t PROPERTY rho- OZC� 0 pry?(r c)?),,,7 <br /> 7 I err ,l� 1� A V �J/1 `, <br /> LEGAL for new construction: Short Plat/subdivision Li/ Lot No.)"/A—(attach copy of long legal description) <br /> OWNER r1C&.. s 1T ... 1'' Phone/E-mail I..t').�1/1.561-- LU 1 1 ACSt`o'" I^ TQ '@, <br /> Address 5t 0 S t y,,e City/State/Zip EJ'� t tiM (.1V94:: <br /> APPLICANT:X Owner _Owners Agent <br /> Contractor _Contractors Agent _Tenant(must provide a letter/off consents� from the owner to do work in the space) <br /> CONTRACTORO� / )&t Q `- '�' )`^ lpre,-,, <br /> l �f.State Lic.# 53 eroH .:1�1SJCity Bus. Lic.# f�J-j5j a <br /> Address pO io24 \31‘ C Je,j \�i (1071-?l Phone/Email Lit 2,5--'34'3 --L03 0 <br /> TENAN BUSINESS NAME ! CONTACT FPRMIT�� �� �st _n'�-yE <br /> •�//I�yIL ` 'L-G 'LJ2 ll5 / f res✓ ,Vt;C' ' <br /> ' Phone/E-mail <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK (.1/ t Od0 <br /> Existing Use of Building- HEAT SOURCE: _ <br /> Proposed Use of Building c) Gas Electric_ OtherX_LO <br /> Building type: Single Family _Duplex Townhouse _Multi-Family Commercial c.71r <br /> Type of project: New Addition _�Remodel Repair_T.I. Sign Sprinkler Demolition Change of Use <br /> DESCRIPTION OF WORK(additional spac rovided on the back): j <br /> p`n1 �{.L /4f <br /> 4 � 1M cam' w ., . ��� <br /> p( O 8- tAf7TAC- ` ..5 S( ) C1,.yyu2A--, <br /> MECHANICAL PERMIT APPLICATION 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 /> A/C—air handling units Toilet <br /> Forced air systems Bathtub <br /> Gas piping Lavatory(wash basin) <br /> Water heater Shower <br /> Gas fireplace Kitchen sink&disposal <br /> Gas range Dishwasher <br /> Clothes dryer Clothes washer <br /> Range hood Water heater <br /> Exhaust fan I Sink(service/bar/mop/etc.) <br /> Heat pump Backflow preventer(inside bldg) <br /> Unit heater Urinal <br /> Boiler I Drinking Fountain <br /> Refrigeration I Floor drain <br /> Woodstove Grease trap <br /> Ducting Roof drains <br /> Other Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM Other: <br /> 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 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 aut 'zed 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 /> (.., <br /> Owner/Authorized Agent Signature Date (Revised 4/2015) <br /> L <br />