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9�2 <br />0 • <br />PERMIT APPLICATION <br />BUILDING/MECNi�NICAL/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 />SIT ZRESS: / <br />PRO PERTY TAX <br />PF,RtdIT <br />- D <br />LEGAL for new construction - Short Plalbsubdivision Lot No._ )attach copy of long legal desctiption) <br />OWNEP� L�')'' aU-S/+ V( ORI1 <br />PhoneyE-m 1 5 Pill /1r970 <br />Address / � J ✓' L Ti24e( <br />Cdy1State7Zip - gZ biA, <br />APPLICANT:_ Owner _OOwners Agent XCon/tractor Conitactors Agent _Tenanl(must piowce a ienn cm ew olori�sent e_,-a .,, loco wen lne space) <br />CONTRACTOR L. 7�Afd� ONE /�UL�i AO) <br />a <br />State Lic. p &T (kS e 70 /CUr City Bus. Lie. # <br />,d <br />Address Po -aj O Q Phone.,Ema.1 �4c d2.Ir�O%dC 5 /OJ <br />TENANT BUSINESS NAME o J <br />,eyr;i <br />CONTACT FOR PERMIT <br />PnonerE-man r AtG/ <br />I� 1\ Q <br />BUILDING PERMIT'A,dPLICATION <br />CONTRACT PRICE WORA <br />Existing Use of Building _ <br />Proposed Use of Building <br />HF,,CT SOURCE - <br />Gas Electric_ Other. <br />Budding type. _ Single Family _ Duplex _Townhouse _ Multi -Family _ Commercial <br />Type of project: _New _ Addition _ Remodel _ Repair _ T.I _ Sign Sprinkle _Demolition_Change of Use <br />P/� <br />` SCRIPTIONOFWORK (additional space provided onttheback) . <br />cinp t/t �jCi'sV ii,q Pi+RA)aC �t. /� fp tut i 4/pt� 4 5 a�lr p% rAli Al -?A) c. <br />r.1ECHANICAL PERMIT APPLICATION <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _-New_Adon Alteration —Repair <br />Show Number (b offIxtures <br />Typoof Project: _New_Addn Alteration _Repair <br />Show Number(A) of fixtures <br />A/C — air handling units <br />I Toilet <br />I Forced air systems <br />I Bathtub <br />Gas piping <br />I Lavatory (wash basin) <br />Water heater <br />I Shower <br />Gas fireplace <br />Kitchen sink 8 disposal <br />I Gas range <br />Dishwasher <br />Clothes dryer <br />I Clothes washer _ <br />I Range hood <br />Water healer <br />Exhaust fan <br />Sink (servicelbar/moplelc.) <br />Heal purip <br />I Backfldw, preventer <br />Unitheater 2.J14 <br />Urinal <br />Boiler <br />I <br />Drinking Fountain <br />( <br />Refrigeration <br />I <br />Floor drain <br />Woodstove <br />Grease trap <br />Ducting <br />Roof drains <br />Other <br />I <br />Medical Gas <br />SPRINKLER <br />/ SUPPRESSION SYSTEM <br />Other: <br />Number of Heads <br />Other: <br />I hereby certify that I have read and e.ammed this application and know the same to be two and correct. Ali provisions of laws and ordinances governing this type of work will be complied <br />well whether spec herein or not. The granting o17°J�ennd does not presume to give authority to violate or cancel the provision of any other slate or local law regulating consW ion <br />That 1 am auth pd opine owner of this propeldorm the work to which applicalion is made and I comply with the Slate Contractors Law 1817 RCW and 196 200A WPC <br />Da O// (Revised 3,2013) <br />