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�- 5$ j - I (C Al <br /> S g- (:). S' 5- . <br /> A I,- <br /> 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: PROPERTY TAX# PEWIT <br /> e:5-LI-7.2/ L c i CZ / Oe(,(\j GU1/9cRO bU 00 c.) l.,1409 - Oe <br /> LEGAL for new construction: Short Plat/subdivision MUlei L /ii6l-'7 S Lot No. /(3 (attach copy of long legal description) <br /> OWNER /Z/( ) (Au5T/wCu crc t C S7r/VC' Phone/E-mail 4425= g—&,S,S1 <br /> Address p 0, /px 0,11 City/State/Zip f yc Y/LLI. C-J4- y93,70 <br /> APPLICANT: Owner _Owner's Agent Contractor _Contractor's Agent _Tenant(must provide a letter of consent from the owner to do work in the space) <br /> CONTRACTOR&ST-At CU 57-0/1-1 //r/( State Lic.#/g1/5 CC 921&C City Bus. Lic.# C)53.33,6 <br /> Address �_(' ,(gdk a�� /`9/i2l�Sl LL- I 7C5-,f[ () Phone/Email //),..57—&76.-- S S/ <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> fJrUL QUS//(i <br /> /t/ '" Phone/E-mail //)._5":&76- l7 5-S7 <br /> n <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK c� 'I[(92b�— <br /> � <br /> Existing Use of Building ///10607.— HEAT SOURCE: <br /> Proposed Use of Building S ( / ,AZIIj54 Gas ) Electric )` Other <br /> Building type: X Single Family Duplex Townhouse _Multi-Family Commercial <br /> Type of project: X New _Addition _Remodel Repair T.I. Sign Sprinkler Demolition Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> (vWU STAG)Cr Ai C-4-,-J 5 Jig <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 3 Toilet <br /> / Forced air systems <br /> S--- Gas piping 9 Lavatory (wash basin) . <br /> j Water heater IN -1-/N G Shower <br /> / Gas fireplace / Kitchen sink&disposal <br /> i Gas range / Dishwasher <br /> Clothes dryer { Clothes washer /A/--L////_ <br /> 1 Range hood <br /> Exhaust fan _ Sink(service/bar/mop/etc.) <br /> Heat pump / Backflow preventer <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 I Other: <br /> Number of Heads Other: <br /> I nereby 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 authorized by the owner 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 /> 77Q p) 3 :2 /�j <br /> Owner/Authorized Agent Si na ure Date (Revised 3/2013) <br />