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F <br />PERMIT APPLICATION <br />BUILDING/MECHANICAL/PLUMBING/SIGN/SPRIN KLER/DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 Cedar St., Everett, WA 98201 <br />ADD <br />425-257-8810 FAX 425-257-8857 wvmeverettima.Org ARE ArCFPTFn FROM 8 AM TO 4 PM 7 —/ . ¢ J —J z <br />SITE ADDRESS: r,d <br />e I <br />PROPERTY TAX IfPER1�1T <br />oo W <br /># <br />C� l a '"� U <br />19 3 .S� E vr�e A <br />LEGAL for new construction: Short Platisubdonsion Lot No._ (attach copy of long legal description) <br />OWNER J-A:Y LAC <br />PhonelE-mail rig } T 2 -3-7 M() <br />ff1C <br />p <br />City/State2ip L[ 'n n teekt ) / On97 <br />Address / z !_'+ <br />APPLICANT: —Owner _Owners Agent _XContractot _Contractors Agent _Tenant lmvst provwealeTar of omwnt tram ve owner to ao xorkmme snacat <br />C,' <br />& I Liic. # Gin, 1 LL c/OC` R�71COE Bus. Lic. # .SI UZz <br />CONTRACTOR Er TT LT altj n , <br />//'' <br />Address S9,�S! L-4a � /V6 (S' nrl/f �� rwi✓'� %OC$Z PhonefEmail Frnrr, 1 f L) r^C&AtL r Cam" <br />TENANT BUSINESS NAME CONTACT FOR PERMIT <br />.Ar"ldrE-L-` 13ovk (i1S)�23Z--S-732— <br />PhonelE•mail <br />CONTRACT PRICE OF WORK <br />BUILDING PERMIT APPLICATION <br />Existing Use of Building X 5/,t/4c.� re4l r�s/A�i�� <br />HEAT SOURCE: <br />Proposed Use of Building s f ` _ <br />Gas�C Electric_ Other_ <br />Building type: r�'_ Single Family _ Duplex _Townhouse _ Multi -Family _ Commercial <br />Type ofproject: New Addition Y Remodel Repair T.I. Sin Sprinkler Demolition Change of Use <br />DESCRIPTION OF WORK (additional spaceprovided on the back): <br />�zlSe/v,..cK JL.QC:h''ct.k i/ tn, <br />/tya(ZM)e <br />Fi✓yt9t-srJK <br />MECHANICAL PERMIT APPLICATION <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _New _ _.Alteration Alteration _Repair <br />Type of Project: _NewX Addn yLAltmation _Repair <br />Show Number (#) of fixtures <br />Show Number (#) of fixtures <br />A/C - airhandlin units <br />Toilet <br />Forced airs stems <br />Bathtub <br />Gas ipin <br />Lavatory (wash basin) <br />Water heater <br />Shower <br />Gas fireplace <br />Kitchen sink & disposal <br />Dishwasher <br />i Clotheswasher <br />Gas range <br />Clothes dryer <br />Ren a hood <br />Water heater <br />Exhaust fan <br />I Sink (servicelbarlmop/etc.) <br />Heal ump <br />Backflow revenler <br />Unit heater <br />Urinal <br />_ <br />Boiler <br />Drinking Fountain <br />Rel2 eration <br />Floor drain <br />Woodstove <br />I Grease trap <br />Ducting <br />Roof drains <br />Other _ <br />tdedical Gas <br />SPRINKLER / SUPPRESSION SYSTEM <br />Other <br />Number of Heads <br />Other: <br />I hereby sanity mat 1 have read and a[amined this application and Meow the same to be two and coned. AN provisions of lases and ordinances governing this typo of work will be rampMed <br />.In whether specified herein or not. The granting of a permit does not presume to give authority to violate or nnoel the prevision of any other slate or local law regulating wristmdion <br />That I am authorized by the owner of this property to perform the we,* for which application 1s made and I comply with the Slate Contractors Law 18.27 RCW and 298.200A WAC. <br />�� �r� '�LAA-1 %,p r 7- /L /Z <br />Owner/Authorized Agent Signature Dale <br />1/1 <br />(Revised W012) <br />