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11/21/2016 MON 11: 09 FAX Feat water Heater 12004/006 <br /> . ERMIT APPLICATION 1- 1 ?n <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.evereftwa-org <br /> SITE ADDRESS: <br /> F Li p . , - 'Oil , /IA MI ' , .-- CILaC2 <br /> • <br /> LEGAL for new construction. Short Plat/subdivision _ Lot No. (attach copy of long legal description) <br /> w _ <br /> OWNERPri <br /> uPhonelE-mall (�S ,7 <br /> � -I v <br /> Address S j I A - <br /> City/State/Zip �Jii:di A .# U <br /> APPLICANT: Owner Owner's Agent ., Contractor Contractor's Agent g Tenant(must prpvlde a letter of consent from Ina owner to du work In Ina apace) <br /> CONTRACTOR f -.G a L. a. e e - .FA- r State Llc, <br /> WWI— ltyBus. Lic.#"Zy <br /> ��, i <br /> Address Of �� . ,Ei� . „P4 IU+, S C p PI/r (U �t3( l Phone/Email <br /> TENAN I3ISINESS 'TAME ,N °�� (U3 ��' ✓F�11 <br /> CONTACT FOR PERMIT p �4-0--{ )/11 <br /> Phone/E-mail c_ :22Vip5.1---1,44-4f...44(., -leAsi- K li <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK I T 0, <br /> Existing Use of Building . (� __ <br /> S <br /> EAT SOURCE: <br /> - <br /> Proposed Use . ". . Q <br /> f , <br /> Gas Electric _ Other <br /> Building type: O‹Single Famil Duplex Townh.use Multi-Family Commercial <br /> T .e of.ro act: New Addition _ Rerflodr: Repair ,.T.I. Sign Sprinkler Demolition Change of Use <br /> DESCRIPTION OF WORK(additional space provided on 9 back): <br /> f,,e,NiAb r la ._ S <br /> .:. . Locw-ur kitoo-e4---- <br /> MECHANICAL PERMIT APPLICATION ' . . MBING PERMIT APPLICATION <br /> Type of Protect: New Acton 1 <br /> AlterationRepair Type o'Protect: New ,Addn Alteration Repair <br /> Show Number(#)of t7xtupoi She. Number(lh)of fixtures <br /> A/C—air handlfne units l Toilet _ <br /> Forced air systems _ Bathtub _ _ <br /> 0 Gad rhea ter _�_ <br /> Westar heater ,:vatory(wash basin) _� <br /> S •war <br /> Gas fireplace Kltcl -n sink&dls.o I <br /> MIEGas ran e <br /> Clothes dr er L . nfshw :her_ " <br /> Ran.a hood Min M._ Clothes '=cher <br /> Exhaust fen Water heat: �` <br /> Neat pump NM Sink servic :r/mo./atc. <br /> Unit heater �— -- Backflow , - . • <br /> r(Inside bldg) <br /> Boiler Urinal <br /> Refti�erativn �'— Orin g Fountain <br /> Woodstove Floor drain <br /> 1111EDuctln. eese{rap <br /> Other 7oal drains <br /> Medical Gas <br /> - • ' — <br /> NKLE ESSION S : EM <br /> Other: <br /> �, Other: <br /> I hereby gerl(ylhal I have rdad and examined(his application and know the Dame to be true and oaIreot • provisions or lawn and ordihancee governing arta 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 pruvlblon of any other otate or local law regulating oonalrucllon <br /> That I m authorized by the owner or(hie property to perform the work for which application le mode and I comply with the Stets Contraciorg Law 18.27 RCw and 256 200A WAC, <br /> flu' ' I — <br /> Owner rizect Agent Signature Date <br /> (Re VAS®d 4/2015) <br />