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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: PR0PEKTYT X# PERMIT# <br /> 410D 5 4 NIC C� R9)2o3 .z9 of 3Z3O o03oo C-ie,C g-00 I <br /> LEGAL for new construction: Short Plat/subdivisionisM itL% j As Lot No. (attach copy of Ibng legal description) <br /> OWNER P�KL� 1\ livIC�* t,A`CksSNik Phone/E-mail Zoe-44b1 •z' 5) <br /> Address SkMt City/State/Zip 5htkF <br /> APPLICANT: Owner _Owner's Agent 'Contractor Contractor's Agent _Tenant(must provide a letter of consent from the owner to dp work in the space) <br /> CONTRACTOR Ky `` �`O/Mf%4\,,,`�‘c `,' , 5A • <br /> State Lic.#�,�(j�EsI{Lgot1..Sb City Bus, Lic.# <br /> Address 42Z"7 z 1� hAt_sC.. Stllmi�N1L'S1\ Wf� • q� Phone/Email 45-.528 .02,52._ <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> tete C.YN]eR '`EL6.RS'081 <br /> Phone/E-mail E z e...*, t•l 1.1I✓.E.i.tONtg:S .Cc <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of Building 55R. HEAT SOURCE: <br /> Proposed Use of Building 55k -V MD).. Gas Electric 4— Other <br /> Building type: bL Single Family _Duplex_Townhouse _Multi-Family Commercial <br /> Type of project: New )( Addition Remodel Repair_T.I. Sign Sprinkler Demolition Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> e,.oST Of 60.5f J to Ott t.DiZtyt 5tUe. .a1.1ST1 ifK. <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New t&. 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 1 ! Toilet <br /> Forced air systems i I Bathtub <br /> Gas piping 1 Lavatory(wash basin) <br /> Water heater Shower <br /> . I Gas fireplace I Kitchen sink&disposal <br /> Gas range t Dishwasher <br /> t Clothes dryer 1 1 Clothes washer <br /> t Range hood t I Water heater <br /> 1 Exhaust fan I 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 /> I Ducting I Roof drains <br /> Other Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM I Other: <br /> Number of Heads r 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 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 /> --<-----; - - -- 313 iS— <br /> Owne Authorized Agent Signature Dat (Revised 4/2015) <br /> r( g g <br /> iI2 <br />