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-PXif-LP-( #�- 2 42,4oD2vo10©o <br />PERMIT APPLICATION <br />BUILDINGIMECHANICAUPLUMBING/SIGN ISPRINKLERMEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 Cedar St., Everett, WA 98201 - 425-257-8B10 - FAX 425-257-8857 - www.everettwa.org <br />AORi rCATKiNA ARF ACCEPTED FROM 8 AM TO 4 PM / , -;,-7 —/ Z <br />SITE ADDRESSS!- PROPERTY7T R T# <br />I -UU <br />30 �vtrti64 /ina ( I Wa c,_ ) Z J <br />LEGAL for new construction: Short PlaVsubdivision Lot No._ (attach copy of long legal description) <br />OWNER 14•C 7 <br />Phone/E-mail <br />Ia-70S rj Zoq"— SV ovii WA <br />City/State/Zip yi b 072>7- <br />Address <br />CONTRACTOR Ctavt Soh S <br />L_81Lic.# CLA(�-ISIRZ"1 Ef3l!1,, <br />_q <br />Address -1ZOu Ne tlS+" S Phone/Email ZS `Cb=j 14'00 <br />TENANT BUSINESS NAME <br />CON', ACT FOR PERMIT th%teart'(-LAr. 159 <br />�(SS bi [pLtv,+Cvs, <br />D01,11,1XICA Grcr11 yZStlBj�bou <br />M� <br />Phone/E-mail <br />BUILDING PERMIT APPLICATION ICONTRACT <br />PRICE OF WORK CL�� <br />Existing Use of Building HEAT SOURCE: <br />Proposed Use of Building Gas-_ Elear:c_ Other_ <br />Building type: Family _Multi -Family _Commercial <br />_Single _Duplex_Townhouse <br />Type of project: _ New _ Addition _ Remodel _ Repair _ T.I. _ SignSprinkler —Demolition—Change of Use <br />Description of Work (additional space provided on the back): I <br />�C� C.I�GlRVL2 <br />NHS{ -a Il � S�15 DC ( V\tf!"that ( L, 11(u (M11nn <br />oh (-aCP ltita11 <br />Have you started working without a permit _YES 'NO <br />MECHANICAL PERMIT APPLICATION <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _New_Addn —Alteration _Repair <br />Type of Project: _New_Addn --Alteration --Repair <br />Show Number (#) of fixtures <br />Show Number (#) of fixtures <br />A/C - air handlinq units <br />' <br />Toilet <br />Forced airs stems <br />Bathtub <br />Gas piping <br />Lavato (wash basin) <br />Water heal=r <br />Shower <br />Gas fireplace <br />Kitchen sink 8 dis sal <br />Gas range <br />Dishwasher <br />Clothes dryer <br />Clothes washer <br />Range hood <br />Water heater <br />Exhaust fan <br />Sink (service/bar/mop/etc.) <br />Heat pump <br />Backflow preventer <br />Unit heater <br />Urinal <br />Boiler <br />Drinking Fountain <br />Refrigeration <br />Floor drain <br />Woodstove <br />Grease trap <br />Ductin <br />Roof drains <br />Other <br />Medical Gas <br />SPRINKLER I SUPPRESSION SYSTEM <br />Other: <br />Number of Heads <br />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 onfiri governing <br />this type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel <br />the provision of any other stale or local law regulating construction or the performance of construction. That I am authorized by the owner of this property <br />to perform the work for whit pplication is made and I comply with the State Contractors Law 18.27 RCW and 296.200 WAC <br />t �a (I -,z -7 - ( -L- <br />Owner/AdWorized Agent I <br />ignature Dale (Revised 22011) <br />