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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: S'E PROPERTY TAX# P RMIT# <br /> /C'3SY '.- /1— A u.e ve -tf/ (.,/if /OjO6©dc/c2 9Cv t5O7 -O Z <br /> LEGAL for new construction:f/ Short <br /> f�Plat/subdivision Lot No. (attach copy ofoflong legal description) /1 <br /> OWNER s;jl`e✓/GL I\,1 �►t/��i�`717e ASC Phone/E-mail JCS/(j I i /014; V 0/0""//c cClii7'i i 7-.JQ <br /> Address/c//7 2'/i' C / St- a City/State/Zip Hi//] CSC if/ L i/'A 5'7o/Z <br /> APPLICANT:_Owner _Owner's Agent X Contractor it ontractor's Agent Tenant(must provide a letter of consent from the owner to do work in the space) <br /> CONTRACTOR ,$T/,id 1 <br /> 2 / �/# ,(�ill J� StateJJLic.#,S/40- ,3S 9 -4C/" City Bus. Lic.#(��z��, <br /> Address//f"( �W 3-7 �l Y. 3E'u L// �1 7 / ?/ O- Phone/Email.?,06.-- . L,Z% 2Q/ i,,„ (91.1,-(4',J.(, ,:,• <br /> TENANT BUSINESS NAME / // .4 C TO-7 <br /> FOR PERMIT / / <br /> S �ii'-�c� 17e '/ 7'1? '�} � r l Stale) i .li ji/.r /ifi e 6r04l/4 cv.� <br /> �� `�` 4�J� Phone/E-mail 2.d6Z-11-11.z Y .Alike C f74C//JJ,r7/l"cQi� <br /> BUILDING PERMIT APPLICATION ll�' CONTRACT PRICE OF WORK 0 ,z,11(t 5 ' <br /> Existing Use of Building Cf7,14wi1 re/.a'/ HEAT SOURCE: <br /> Proposed Use of Building '„jstvieC / A • C/ ea/74 Gas Electric Other <br /> Building type: _Single Family _Duplex_Townhouse Multi-Family Commercial <br /> Type of project: _New _Addition _Remodel _Repair_T.I. Sigtg_Sprinkler_Demolition_Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> -1-‘11.1a///� t1Gley/,c AvNc'v(j,Qic / �'G1. <br /> ff� �J <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 Dishwasher <br /> — <br /> Clothes dryer Clothes washer <br /> Range hood Water heater <br /> Exhaust fan Sink(service/bar/mop/etc.) <br /> Heat pump Backflow preventer <br /> Unit heater <br /> B ( Urinal <br /> Boiler <br /> _ 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 /> — <br /> 1 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 1 am authorized bthe 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 /> 1 <br /> CY i-/Off /5" <br /> Owner/ uthorized Agent Signature ate (Revised 9/2014) 1112— <br />