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• <br /> PERMIT APPL,ICATIGdl <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: PROPERTY TAX# PERMIT# <br /> C12I CDS y . /j'IE . Oo39s4/-7 6OO5.O0 (a-'0,2 f <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of[Ong legal description) <br /> OWNER FvA/-t 0,4/2"riA_JELL._ 1-92-5. <br /> Phone/E-mail y2— 23-7 Li_S-3 <br /> Address 12- t COI 6y ALic City/State/Zip .f6.2E11-- W 4- q"-2-ti ) <br /> APPLICANT: Owner _Owner's Agent V Contractor _Contractor's Agent _Tenant(must provide a letter of consent from the owner to dp work In the space) <br /> CONTRACTOR /?--e-1 n c 6i4P'va6 LS 1 A--)e- State Lic.# p,,,,--,1 DS S'J N City Bus, Lic.# <br /> # sag y-2s z. <br /> Address 2-DO`( l nL�r A_v& ur"'' 6' E.v6)2.i7 �Q S�20 Phone/Email cn.c'.sol, e'it-c rH c 6.4,24 h1-s- zt^ <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT Z S4-5 5 Z <br /> Phone/E-mail 5..o- cLSo'v6?AEp.,cL rt=e, LO'S • <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK 32-i vo�.C'`- <br /> Existing Use of Building Ait.10-i'l i HEAT SOURCE: <br /> • <br /> Proposed Use of Buing 6gIn-,�G., GasGas Electric Other <br /> Building type: !7-Single Family Duplex_Townhouse _Multi-Family —Commercial <br /> Type of project: .L' New _Addition _Remodel _Repair T.I._Sign Sprinkler Demolition Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> Can-) 7,1 c.J - A/67-v 2_V1-i,,.26 r 6-d7 rtr--ef'ED ,,,GJ -/.,B-,/'-)r c' 6i2.6nr.v6 <br /> • <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New_Addn Atte tion_Repair Type of Project: New_Addn Alteration_._Repair <br /> Show Number(#)of fix res Show Number(#)of fixtures <br /> NC-air andling units Toilet /J <br /> Force air systems Bathtub <br /> Gay iping 1 Lavatop/(wash basin) <br /> I Water heater I Sher <br /> ;Gas fireplace Kitchen sink&disposal <br /> Gas range Iishwasher <br /> / Clothes dryer Clothes washer <br /> lj/ Range hood Water heater <br /> Exhaust fan Sink(service/bar/mop/etc.) <br /> /_ Heat pump Backflow preventer(inside bldg) <br /> Unit heater Urinal <br /> Boiler i Drinking Fountain <br /> Refrigeration Floor drain <br /> Woodstove J Grease trap <br /> Ducting Roof drains <br /> Other Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM Other: <br /> Number of Heads 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 ordinances governing this type of work will be complied <br /> with whether specified 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 /> That I am aut zed b €. ne of this property to perform the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> � • -?//i <br /> Owner/Authorized Agent Signature Date (Revised 4/2015) <br />