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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# MIT# <br /> -1° LoM 0e. & b� 72Z.31v0'$0D P R (r206 - &'$' <br /> LEGAL for new construction: Short Plat/subdivisiongt-oAd'Ia L--^A �" Lot No. (attach copy of long legal description) <br /> OWNER Ch 1 O r b Sir O n Phone/E-mail I Z S r K ^7 0'/,5-- <br /> Address <br /> ySAddress 1117 L y-,16,,r J AVC. City/State/Zip �:. Ve.re-+f vJA. "-17 Za 1 <br /> APPLICANT: Owner Owner's Agent X Contractor Contractor's Agent »_Tenant(must provide a letter of consentfrom the owner to do work in the space) <br /> CONTRACTOR FW(� CSO S-rL-T► Oil! State Lic.# FW G 3y7P City Bus. Lic.#05251961 <br /> Address 2-0'-7670 ly 421—" v, e- Phone/Email 2 rj 75`1-y'9 <br /> TENANT BUSINESS NAME CONTACT OR PERMIT <br /> Cleo L ',a Lf -/ -S s/y�- fIi7 <br /> Phone/E-mail Eo-Ap. I /✓L cl t D✓ vvL"^Sf'"r -4,1 LO <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK 11`J., opt) <br /> Existing Use of Building R25i cL¢.-�.CX- HEAT SOURCE: <br /> Proposed Use of Building 4-, 1 a ,C V C.—, Gas Electric Other_ <br /> Building type: 9 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 /> i vu .ZGtCQ <br /> Vld bL S-f�i ct�-Fug f yl +P-t/l UY -Stu C ( kl Su-g�o'k <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New_Addn _Alteration Repair Type of Project: _New_Addn _Alteration 4Repair <br /> Show Number # of fixtures Show Number # of fixtures <br /> A/C-air handling units 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 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 I 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 1 amauth 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 /> 07terlAuthoeVed Agent gz, ature Date (Revised 4/2015) <br />