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I <br /> 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# PE IT <br /> LEGAL for new construction: Short Plat/subdivision L-k," `'Ll, "s$L C Lot No. (attach copy of long legal description) <br /> OWNER i-f(,�gck ��v ^�'1� yes Phone/E-mailLSC\C1c�Lj►-� \err, ( e,--'I <br /> >- c <br /> Address3927- �3 1 t A"V,-- IV F— City/State/Zip MAW\ Sli l'E C4'� �—? <br /> APPLICANT: Owner _Owner's Agent,1 11__ C__ontractor _Contractor's Agent _Tenant(must provide a letter of consent from the owner to do work in the space) <br /> CONTRACTOR 1+ACXCk Ai'6beVS OO of Sttatte,Lic.# V40L0,k �T01 'X DZ-City Bus. Lic.#05 'IC <br /> Address y 2.Z K 7+' A� IVC 1 ` A#r SU` l J� �S'-- 2- qv-- 2—q2-1 <br /> L t, c Lb 1Ct(ttl c�j►ra��P�S. (r�,M <br /> 1 �- �® Phone Email 5 � � ' <br /> TENANT BUSINESS NAME CONTACTFOR PERMIT <br /> ,� ,j v�.lC���1(ld�,'�rvhlc9Vr.(c�� <br /> Phone/E-mail ?—W- 2-;-4 Z c <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK 3 -0 V-� <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building !Q, Gas vh Electric Other_ <br /> Building type Single Family _Duplex_Townhouse _Multi-Family _Commercial <br /> Type ofproject: New Addition Remodel Repair T.1. Sin Sprinkler Demolition Chane of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> INJ T-\2 '� AC- .it- 1S 31 <br /> 9,(3 i50 Z - cc) 2- <br /> MECHANICAL <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project:XNew_Addn _Alteration_Repair Type of Project:7 New_Addn _Alteration_Repair <br /> Show Number(#)of fixtures Show Number(#)of fixtures <br /> A/C—air handling units T Toilet <br /> Forced airs stems Bathtub <br /> Gas piping Lavatory wash basin <br /> Water heater Shower <br /> Gas fireplace Kitchen sink&disposal <br /> Gas range Dishwasher <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 Urinal <br /> Boiler Drinking Fountain <br /> Refrigeration Floor drain <br /> Woodstove Grease trap <br /> DuctingRoof 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 wffi <br /> d herein or not.The gr nting 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 t ner is pr a rform 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 /> Owne Aut rized Agent Sig Ire Date (Revised 9/2014) <br /> �/3 <br />