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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# PERMIT# <br /> t ORE AVE do 6667-2002300 <br /> LEGAL for new construction: Short Plat/subdivision 22.0- l / 00 Lot No2234& (attach copy of long legal description) <br /> OWNER ` K/1 � ROI Q E�T Phone/E-mail ro I (IVB <br /> Address 14 Y�[ ET► 1OKE City/State/Zip EyE R 9820I <br /> APPLICANT:_Owner X Owner's Agent Contractor Contractor's Agent Tenant(must provide a letter of consent from the owner to do work in the space) <br /> CONTRACTOR V State Lic.# City Bus. Lic. # <br /> Address Phone/Email <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT EFF MAZUREK <br /> Phone/E-mail 206-724 -4513 je-FemgzurekQr,.hi-6 m. <br /> com <br /> BUILDING PERMIT APPLICATION CO�NTRACT PRICE OF WORK <br /> Existing Use of Building siNGLF–FAM(L`( �FLL1k1/ HEAT SOURCE: <br /> Proposed Use of Building 5J N GLE –PAMIL` 2JC/-LLLf�1 G Gas Electric — Other <br /> Building type: %X Single Family _Duplex_Townhouse _Multi-Family _Commercial <br /> Type of project: New Addition Remodel Re air T.I. Sin Sprinkler Demolition Chane of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): /"t A 10 <br /> CONMUGT >6, NEw DORMEFZ ;K ADID A �3A-rHRCCN,4 AT <br /> THE QPPEP LEUEL OF EXISTING SINGLE - PAMIL`( [JOUST <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New_Addn _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 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 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 I am authorized y e owner of this property to performthe ork for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> i <br /> 1/30/2015 <br /> Z <br /> Owze gent Signature i Date (Revised 4/2015) <br />