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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:$I <br />3OS SE eVQ(Ma" WQ4 <br />PROPERTY TAX <br />o 180030 <br />Z- <br />LEGAL for new consnuchon She,. PlaVsubdrv,sron Lot No _ (attach copy of long legal descnol on) <br />OWNER 6'rg-2ii't (( OC — <br />Phone/E mar V _ <br />.. ll/L[,� I,U-C <br />Address I2II St� �/ -r <br />SW <br />GtylStatelZa 'f- A� O '' ao <br />APPLICANT:_ Owner _Owner's Agenl yContractor _Contractor's Agent _Tenant lmvsc yo.ueaeeer cicws<+t rrom theone co pov�t nvc;w:rl <br />CONTRACTOR Q Cr!,$i n S Elms <br />State Lic. # e' rl <br />City Bus. Lic. # L/oc 6 <br />i <br />Address o ( 8v�3 <br />PhonetEmal .75- <br />TENANT BUSINESS NAME <br />S��{1I/ (� <br />"` geau4y Siyp(y <br />CONTACT FOR PERMIT E T <br />6/Qf1-IlJ4Go bS <br />Phcne'E.mail '+o S UE�i Si rtS S C rCoM <br />BUILDING PERMIT APPLICATION <br />CONTRACT PRICE OF WORK 3SO- Du <br />Existing Use of Building I HEAT SOURCE: <br />Proposed Use of Building I Gas Electric Other <br />Building type: _Single Family _Duplex _Townhouse _Multi -Family Commercial <br />Type of project New Addition Remodel Repair T.I. Sin —Sprinkler Demolition Change of Use <br />DESCRIPTION OF WORK (additional space provided on the back): <br />-4,-M5+411 (I) I11Ui1' 1014PQ VJA Sigh <br />MECHANICAL PERMIT APPLICATION <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _Now_Addn _Alteration_Repalr <br />Show Number a offixtures <br />Type of Project: _New_Addn _Alteration_Repair <br />Show Number # offi■tures <br />AIC- airhandli units <br />Toilet <br />Forced air systems <br />Bathtub <br />Gas piping <br />Lavatory wash basin <br />Water healer <br />Shower <br />Gas fireplace <br />Kitchen sink 8 disposal <br />Gas range <br />Dishwasher <br />Clothes dryer <br />Clothes washer <br />Rancie hood <br />Water heater <br />Exhaust fan <br />Sink servicelbarlmo lets <br />Heal pump <br />Baekflow preventer <br />Unit heater <br />Urinal <br />Boiler <br />Drinking Fountain <br />Refrigeration <br />Floor drain <br />Woodstove <br />Grease trap <br />Ducling <br />Roof drains <br />Other _ <br />Medical Gas <br />SPRINKLER / SUPPRESSION SYSTEM <br />Other: <br />Number of Heads <br />Other: <br />I hereby ce are read and examined INS apd+wlan and know the same to be true and correct. AE provisions of laws and ordinances govern ig this type of work wil be comp <br />wen whether ed herem or nil The granting of a penol does not presume to give authority to violate or cancel the provision of any other state or local law regulating comlruclOM <br />That I am authorbed by the owner of this property to perform the work for which appl"ton is made and I comply w1h the Stale Contractors Law 16 27 RCW and 296 2110A WAC <br />- I eu.A, <br />Owner/Authorized Agent Signbrure Date (Revised 912014) <br />