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PERMIT APPLICATION <br />BUIL DING/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 />i --al -I S <br />SITE ADDRESS: rf''Ff" lI <br />50 <br />PROPERNT it�� <br />U d TLot <br />O _ <br />P I,no <br />LEGAL for new construction.Short No._ (attach copy of long legal descnption) <br />�Plat/subdivisio <br />OWNER S P� 1 f (A (i <br />PhonelE-mail <br />Address <br />Cily/5latelZip <br />APPLICANT:_Owner _Ovmer's Agent XContractor _ Conlractors Agent _Tenant (.,wa ro�aeaurtei of ccmem xom wea yr to do wcn mtne sp+al <br />CONTRACTOR QQ <br />State Lic. # -X Sir1 City Bus. Lic. #C) j a <br />Address pIGJ r " � <br />Ph�Joneo mail, -13y3 <br />rE - i -0O2cYi <br />TENANT BUSINESS NAME <br />---D <br />CONTACT FOR PERMIT <br />Lor:� -;i5t L) <br />Phone/E•mail r; e + —, 1 ri. <br />BUILDING PERMIT APPLICATION <br />CONTRACT PRICE OF WORK � (-) CSCSC) �c <br />Existing Use of Building I HEAT SOURCE: <br />Proposed Use of Building re") Gas Electric Other <br />Building type: _ Single Family _ Duplex _Townhouse _ Multi -Family ,� Commercial <br />Type of project: New Addition Remodel Repair T.I. Si Sprinkler Demolition Change of Use <br />DESCRIPTION OF WORK (additional space provided on the back) : <br />repl,co- S;5n5 L. )*- 4- <br />MECHANICAL PERMIT APPLICATION <br />PLUMBING PERMIT APPLICATION <br />Typo of Project: _New_Addn _Alteration_Repalt <br />Show Number (#) of fixtures <br />Type of Project: _Now_Addn _Alteration_Ropalt <br />Show Number (a) or (xtures <br />NC -air handling units <br />Toilet <br />Forced airs stems <br />Bathtub <br />Gas piping <br />Lavatory wash basin) <br />Water heater <br />Shower <br />Gas fireplace <br />Kitchen sink 8 disposal <br />Gasran a <br />Dishwasher <br />Clothes dryer <br />Clothes washer <br />Range hood <br />Water healer <br />Exhauslfan <br />Sink (service/bar/mop/etc.) <br />Heal pump <br />Backgow preventer (inside <br />bld ) <br />Unit healer <br />Urinal <br />Boiler <br />Drinking Fountain <br />Refrigeration <br />Floor drain <br />Woodslove <br />Grease Ira <br />Ductln <br />Rool drains <br />Other <br />Medical Gas <br />SPRINKLER 1 SUPPRESSION SYSTEM <br />other: <br />Number of Heads <br />Other: <br />I hereby centy Nat I have read and e.amined Ibis application and know the same to be true and correct. NI provisions of laws and ordinances governing this type of work wil be comp <br />with wheth rspeafipd herein or not. The granting orapermd doesnolpresume to give authony to violate or cancel the provision of any other state or local law regulating construction <br />Thal I a a ori2ed b he <br />o . of Ni ropery to perterm the work for which app6ralgn is made�nd I compywith the Stale Contractors Law 18.27 RCW and 296 200A WAC. <br />h lP� <br />ono Au horized Agent Signature - t (Revised 412015) <br />II? <br />