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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: PROF RTYT # PER T it <br /> C t-✓fl i2 <br /> 5 2 Wet !qv e 00 Y� G I l// ad scj .15014-012_ <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> r <br /> OWNER Srn if 1-le' M ire ii 4P( /3 ¢ 7r i/ /( Phone/E-mail 3 C G - 2 3(- ,2 r/S <br /> Address 5-01-C (i!jlIiidAf ��/(�_ City/State/Zip 1ifie-Q� wit /?)-C) <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 /')(OA) (pin/s f L)i✓ State Lic.# /U'rx j4) 4 70/c.._ City Bus. Lic.# O1/27 7 3 <br /> � � /� r <br /> Y <br /> Address c /ry tk r (I 3 7 6-,Q4/ait' mt Phone/Email 4,4S---- 1/(�.-j q l5 <br /> TENANT BUSINESS NAME ONTACT FOR PERMIT r <br /> .k.-. ec.� iv /�.,&✓ , Xcin/ <br /> Phone/E-mail e/25-' / '7. c 4r <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK Pr l 7,C r <br /> Existing Use of Building 41J 1 9♦ HEAT SOURCE: <br /> Proposed Use of Building '3 f-/n Gas x Electric Other <br /> Building type: A Single Family _Duple/_Townhouse _Multi-Family _Commercial <br /> Type of project: New 10 Addition I Remodel Repair T.I. Sign Sprinkler Demolition Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> AleW - e, `i, / _m ' 0e/ -- double oiee'er Sart <br /> [O)tC becv.roo(vA, c[osef, ba-t1, bonus room, <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New XAddn Alteration_Repair Type of Project: _New/t_' Addn _Alteration_Repair <br /> Show Number(#)of fixtures Show Number(#)of fixtures <br /> C A/C—air handling units 1 Toilet <br /> Forced air systems j' Bathtub <br /> ,� Gas piping > Lavatory(wash basin) <br /> Water heater / Shower <br /> Gas fireplace Kitchen sink&disposal <br /> Gas range Dishwasher <br /> Clothes dryer Clothes washer <br /> j Range hood Water heater <br /> Exhaust fan I Sink(service/bar/mop/etc.) <br /> t Heat pump I Backflow preventer <br /> Unit heater Urinal <br /> I Boiler Drinking Fountain <br /> Refrigeration Floor drain <br /> Woodstove 1 Grease trap <br /> I Ducting Roof drains <br /> Other Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM I Other: <br /> Number of Heads I 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 compl <br /> with whether specified herein or not.The granting of a permit doesnot 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 /> ✓/� � rI /1, � - 5 - q /c [ <br /> Owner/Authorized Agent Signature Date (Revised 9/2014) N. L <br />