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02/17/2015 TUE 13:14 FAX 425 379 7045 WA Natural Gas 10001/001 <br /> PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/S PRI NKLEPJDEMOLITION <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 T# <br /> 2 G � v� �V«�TT bi i U 4- 5C3 <br /> LEGAL for new construction: Short Platisubdivision Lot No. (attach copy of long legal description) <br /> OWNER `C I �k'Fz(" t IiAc -e Phone/E-mail T2 -35-5' -3'331 <br /> Address TGV- %L `ri to 74v--- City/State/zip Q qX so <br /> APPLICANT:—Owner _Owner's Agent Contractor Contractor's Agent _Tenant(must provide a letter of consent from the owner to 0o vmrk in the space) <br /> CONTRACTORA !V&(.T 6615 'T ,C' State Lic.# 6 y1 L D City Bus.Lic.# <br /> Address Phone/Emaii <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT:O,Q,-( l 1 V-CL(- ., <br /> Phone/E-mail C-O Y�^� <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 ^Commercial <br /> Type ofproject: New Addition Remodel Repair T.I. Sin Sprinkler Demolition Chane of Use <br /> DESCRIPTION OF WORK/additional space provided oJ/n tt�he back): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New_ ddn _Alteration_Repair Type of Project: —New_•Addn _,Alteration_Repair <br /> Show Number #)of fixtures Show Number # of fixtures <br /> A/C-air handling units Toilet <br /> Forced airs stems Bathtub <br /> Gas pipin2 Lavatory wash basin <br /> Water heater Shower <br /> Gas fireplace i Kitchen sink&disposal <br /> Gas range Dishwasher <br /> _�.- <br /> .—._-----_--._-._.._--.--}-------Clother-dryer_.___........__..__...__.._._.__...... washer-_...._.__._._._....._.-._.-----...-----------....._.__----- <br /> Ran e hood Water heater <br /> Exhaust fan Sink service/bar/mop/etc.) <br /> Heat pump Backflow reventer <br /> Unit heater <br /> Urinal <br /> Boiler Drinkino 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 certi al I have read and examined this application and know the same to be[rue and correct.All provisions of laws and ordinances governing this type of work will be comp <br /> vri[h whet r ecified 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 I a aut orized by 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 /> �� ( / 5- <br /> O ner/A th zed Agent Signature Date (Revised 912014) <br />