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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: w VE PROPERTYi�X# \ P ,!I�O 4 _0r j� <br /> Q111 ST�J AVC 00 5 ��cot�-�ov (v�l IBJ <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER MA) L1.\JLEk Phone/E-mail Si4 - t:yNu.t,aw <br /> Address x'111 5 TN nti� Li. Vc�ETT ��, �2,1'04 City/State/Zip <br /> APPLICANT: \ Owner _Owner's Agent Contractor _Contractor's Agent _Tenant(must provide a letter of consent from the owner to doworkin the space) <br /> CONTRACTOR LE 1. ^! Lti"t`K/) c �j E Ar c, State Lic.# AcC V Rt 14-L' City Bus. Lic.#(13--1( <br /> Address F -' I C 5 M.pr b.i P. 11.7 Phone/Email *IS S (,-5' J <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> AS L Lt R. <br /> Phone/E-mail <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK 13 i1 JU <br /> Existing Use of Building 51 v�LC F No\IL/ P.E )t)t N HEAT SOURCE: <br /> Proposed Use of Building ` 1 '.V Vt LL PNPAit_y �.�5\[ NC- Gas Electric X Other <br /> Building type: X 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 /> 1-Eck 1>oNAI eJ E1(t51- .1\j CA,-r T \No 5v(r_D (a-Ar AtA-E �.! ZNO S of T F <br /> SOC tta.J AL L t /k Pkt 5,!PTA- <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 41. Bathtub <br /> Gas piping Lavatory(wash basin) <br /> Water heater Shower <br /> Gas fireplace Kitchen sink&disposal <br /> Gas range Dishwasher <br /> Clothes dryer I i Clothes washer <br /> Range hood <br /> 3 Exhaust fan Sink(service/bar/mop/etc.) <br /> Heat pump Backflow preventer <br /> 7 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 /> 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 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 /> 29vc rL__ 4- k1"? f- 4--\S Z- <br /> Owner/Authorized Agent Signature Date (Revised 9/2014) <br />