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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: . PROPERTY TAX# PERMIT# <br /> 2-00 3 __1 �.tSY Vic, CilN161- 001 <br /> LEGAL for new construction: Short Plat/subdivision 55 Iii"00 7 Lot No.9% (attach copy of long legal description) <br /> OWNER lia r f'''C'+V\(:.4-i' 1 trv\PS Phone/E-mail 125 ci 0-- iZA1 1 d'ecte ixcick6 eil,tool <br /> Address L S 1 lib jT �` � City/State/Zip kv y tU•` \`€ L`-4\ , 1 e_7 <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 4c \.0 8i"-1N-ev 3 State Lic.# C\C1[kt(13 0Z- ie <br /> City Bus. Lic.#155.3.3'6 7 <br /> tb <br /> Address t,C127 S.1 k Phone/Email ,L 1 (1CL�lCIc i0' ajt�d},()M <br /> TENANT BUSINESS NAME 'CONTACT FOR PERMIT •V <br /> r .�ce l N-atlt <br /> Phone/E-mail -ALS 210`2 Z-9 <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK A ICOSIc <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building S F F- Gas Electric Other <br /> Building type: \f. 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 /> 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 /> i , I Forced air systems bosi-d Bathtub <br /> li Gas piping t�,y ,(GM I Lavatory(wash basin) <br /> I Water heater / / Shower <br /> t I Gas fireplace pm(D i Kitchen sink&disposal <br /> Gas range 1 L____! Dishwasher <br /> i Clothes dryer 1 Clothes washer <br /> Range hood UkA) Water heater <br /> e Exhaust fan Sink(service/bar/mop/etc.) <br /> i Heat pump i Backflow preventer(inside bldg) <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 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 comp <br /> with whether specified herein or not. I-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 a autho d by the o, ner of this.roperty 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 /> 9 -' t4I9 <br /> Own r/Aut orized Agenature iti <br /> Date (Revised 4/2015) <br /> lid— <br />