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P <br />PERMIT APPLICATION <br />BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br />CITY OF EVERETT PERMIT:iERVICES <br />3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br />3-)3-)V <br />SITE ADDRESS: ., <br />>?vS Lour-rla+2i Ave UNI>`A <br />PROPERTf TAX <br />PERM IT# <br />I NIA <br />LEGAL for new construction: Short Plat subdivision Lot No._ (atlach copy of long legal description) <br />Phone/E-mail 'Z 5 3 38 -W Ste' <br />Ri <br />v OWNER / N 2.17 in,1 <br />Address 719a 105"'54-5E <br />City/State/Zip 6tw rzfi-� wA' %a al <br />APPLICANT: —owner X Owner's Agent _Contractor Contractor's Agent _Tenant (must provicoale9er of consent ,om!he ownere do worm mo¢pacal <br />CONTRACTOR V-)AS4•N �A.Li-,--1 +u11 / <br />12Ar5 <br />State Lic. # City Bus. Lic. # <br />/I <br />Phone/Emailuw C4. corn <br />Address <br />CONTACT FOR PERMIT <br />TENANT BUSINESS NAME <br />Phone/E-mail <br />BUILDING PERMIT APPLICATION <br />CONTRACT PRICE OF WORK <br />Existing Use of Building Ica A. . HEAT SOURCE: <br />r <br />Gas X Electric_ Other_ <br />Proposed Use of Building <br />Building type: Single Family �- Duplex _Townhouse _ Multi -Family _ Commercial <br />_ <br />Type of project _New _ Addition _ Remodel _,Repair _ T.I. _ Sign _Sprinkler _Denolition_Change of Use <br />DESCRIPTION OF WORK space provided on the bate): <br />Re-elatet "'&r /1edz� - <br />MECHANICAL PERMIT APPLICATION <br />PLUMBING PERMIT APPLICATION <br />Type of Project: <br />_Alteration _Repair <br />Typo of Project: __New <br />_Addn _Alteration _Repair <br />_New <br />Show <br />_Addn <br />Number (#) of fixtures <br />Show <br />Number (N) of fixtures <br />Toilet <br />A/C - air handling units <br />Bathtub <br />Forced air systems <br />Lavatory (wash basin) <br />Gas piping <br />Shower <br />Water heater <br />I Kitchen sink &disposal <br />Gas fireplace <br />Dishwasher <br />Gas range <br />G <br />Clothes washer <br />Clothes dryer <br />Water heater <br />Range hood <br />Sink (service/bar/mop/etc.) <br />Exhaust fan <br />Backflow preventer <br />Heal pump <br />Urinal <br />Unit heater <br />Drinking Fountain <br />Boiler <br />Floor drain <br />Refrigeration <br />Grease trap <br />Woodstove <br />Roof drains <br />Ducting <br />Medical Gas <br />Other_ <br />Other: <br />SPRINKLER <br />/ SUPPRESSION SYSTEM <br />Number of Heads <br />Other: <br />I hereby cedlfy Ihal I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing Ihis type of work will be complied <br />weh whether specked 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 />Thal I a a horized by the ovine his property to perform the work for which application is made and I comply with the State Contractors Law 16.27 RCW and 296.200A WAC. <br />3 i5 ►4 <br />OwneryAuthorized Age Slgnaturc Ogle (Revised 3/2013) <br />