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03/04/2015 WED 8:27 FAX 425 379 7045 WA Natural Gas Z001/002 <br /> C� a57 33 <br /> PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRIN KLER/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: �4•f�Cr��T PROPERTY TAX# 1 44PERMIi;�,� 3 43 <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br /> OWNER Ccako-4 Phone/E-mail 4-2-5-34-1– 23Z <br /> �yV <br /> Address,Lo-v, -—-J ex-e5� ��' ^3 City/State/Zip ��'�"'t f� W3 <br /> APPLICAty l:—owner _Owner's Agent _Contractor —Contractor's Agent _Tenant(must Provide a leuor of conserve from the o—er to do vrork in the space) <br /> CONTRACTOR rcc5 �E &L V State Lic.# WJA*kn qt3 LCA City Bus.Lic.# <br /> 2(i tS k: t-o �;t lT� 2- <br /> Address e Ce WA- .t,2-W Phone/Email <br /> TENANT BUSINESS NAME ( CONTACT FOR PERMIT <br /> 1ef ` r to Phone/E-mail ri (.?C k' k U K-C. `. °CC)VI <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building Gas Electric Other <br /> Building type: _Single Family _Duplex__-_,Townhouse _Multi-Family u Commercial <br /> T e of project: New Addition Remodel Repair T.I. Sin Sprinkler Demolition Chane of Use <br /> DESCRIPTION OF WORK(additional space provided on the back <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New—Adds _Alteration R pair Type of Project: _New�Addn _Alteration_Repair <br /> Show Number(#)of fixtures Show Number(#)of fixture-, <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 i Kitchen sink&disposal <br /> Gas range ( Dishwasher <br /> Clothes dryer i Clothes washer <br /> -- _.... ,.... .. _ -------- <br /> Range <br /> -.Ran e hood I Water heater <br /> Exhaust fan i Sink(service/bar/mop/etc.) <br /> Heat pump Backflow preventer <br /> Unit heater Urinal <br /> Boiler ; Drinking Fountain <br /> Refricleration { Floor drain <br /> Woodstove Grease fro <br /> Ducting i Roof drains <br /> Other i Medical Gas <br /> SPRINKLER/ SUPPRESSION SYSTEM Other: <br /> Number of Heads Other: <br /> I hereby certif a 1 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 vineth spe Tried 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 uthor ed b e owner of this property to erfor the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> 03o`til� <br /> Owrier/Authorized Agent Signature I Date (Revised 8/2014) <br />