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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: I TVPROPERTY TAX#2805 -72Ao PE IT# _ <br /> t 2a� 511=5 -�. E r-� r-c , GSE 1.06e366046-7Z0( .3 I Z - 02_3 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> C42 )252)--Z8(Z <br /> OWNER 'PPP4W(TJEf-iC_VE+Csrtof-{at�MA4ScC--f 'f hone/E-mail t204412 4.'iG{ ria•"" --f-JGC-.61r-�, <br /> Address 1.32.( «-�(,•1�. A,-LE• City/State/Zip GtilG-F'T`C• we, (;)g2,Q�p <br /> APPLICANT:_Owner X Owner's Agent _Contractor _Contractor's Agent _Tenant(must provide a letter of consent from the owner to do work in the space) <br /> CONTRACTORPir-aYC(CZ MCCAL d,. refeState Lic.# City Bus. Lic. # <br /> Address G r°N6. Phone/Email X .1-(f..r;.G.gEaf-.-T-a Swozz2(5((..dv,a, <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> P7-4a e t2Ee./( L.h/ (L-Gr CC-'(e 0425)2 •686.f3 <br /> exit'r✓tk'-('(Ef-tr Ekte,A4-t Phone/E-mail dein .cat <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK 4, f Off, GYM <br /> Existing Use of Building ME•t'k ' L. GL,f[LfG. G>L11 -�/4ttl5i-/.1 HEAT SOURCE: <br /> Proposed Use of Building A(.,Gt_( .e3 LTC-VA-CI Gas Electric Other <br /> Building type: Single Family _Duplex Townhouse _Multi-Family x 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 /> 6 s A!-L I~IS('x3111-1C., GSU 'A-'CZ v*4-r G c.(t-L t G .e4.4 <br /> {SLC 2 -tbA- cY'i A t-LCV' <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 j Lavatory(wash basin) <br /> Water heater j Shower <br /> Gas fireplace Kitchen sink&disposal <br /> j Gas range Dishwasher <br /> Clothes dryer j 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 Floor drain • <br /> Woodstove Grease trap <br /> fiDucting Roof drains <br /> Other i 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 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 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 /> t2.1-7• I <br /> Owner/Authorized Agent Sig Date (Revised 3/2013) <br />