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rERMIT APPLICATIOPI <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 /> c[i <br /> SITE ADDRESS: ti PROPERTY TAX# PERMIT# <br /> L 1 H 014' ve X1116700009 tooK 1.rj,0 7 <br /> LEGAL for new construction: Short Plat/subdivision _ Lot No. (attach copy of long legal description) <br /> OWNER Show 445 C0.4141 Phone/E-mail �,/y� <br /> Address (O (��o 7op City/State/Zip Everet ""'+ 1n, <br /> APPLICANT: Owner Owner's Agent Contractor Contractor's Agent /► Tenant(must provide a/l�ettteer of consent from the owner to do work in the space) <br /> CONTRACTOR ("14f%soucrI Fier Pv+'VGliovi q y State Lic.# A®VA tJ )Gt ?t b City B-us.. Lic.# <br /> ( <br /> Address 90 o)� IST) Woo 0,01„ (e tin `d O7ti Phone/Email �r 41/3-Jp <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT �� A,,�� <br /> c 4 t464u Ce•v 'v`�! <br /> Phone/E-mail ,`)� � Q 4.4v uj?YJIC4 <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE 6F WORK 1114 000 <br /> Existing Use of Building !'rY1 f}v' HEAT SOURCE: <br /> Proposed Use of Building i4Yrte Gas Electric Other <br /> Building type: Single Family Duplex Townhouse Multi-Family )0 Commercial <br /> Type of project: _New _Addition Remodel _Repair T.I._Sign 4Sprinkler Demolition Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> Add 41 r ea dcrt vfnKl ev3 rev^ NF°A 1) Pr, keHe,t- i hrev,son Art• <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: New_Addn _Alteration_Repair Type of Project: _New_Addn _Alteration_Repair <br /> Show Number(#)of fixtures Show Number(#)of fixtures <br /> A/C—air handling units Toilet <br /> Forced air systems Bathtub <br /> Gas piping Lavatory(wash basin) <br /> Water heater Shower <br /> Gas fireplace Kitchen sink&disposal <br /> Gas range I Dishwasher <br /> Clothes dryer I Clothes washer <br /> 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 Drinking Fountain <br /> Refrigeration Floor drain <br /> Woodstove Grease trap <br /> Ducting Roof drains <br /> Other Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM Other: <br /> Li- 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 comp <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 authorized by the o er 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 /> .'7/ hs <br /> Owner/A r d Agent Signature Date (Revised 4/2015) <br />