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PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBI NG/SIGN/SPRINKLER/D EMOLITION <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: 13110 PYrlyLij_ v,e/L/LGr E1oif( PROPERTY TAX# PERMIT# <br /> vtv b�'/b Gr7c 2 eCS- 00D4C 5Co¢ o�G' GS" OC <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER LUL( y C-" CO Phone/E-mail <br /> Address 10(,* H� Wt�- City/State/Zip` I/)��►+ I��LQ. I1�. IDOOI <br /> APPLICANT:_Owner _Owner's Agent _Contractor _Contractor's Agent v I enant(must provide a letter of consent from the owner to do work in the space) <br /> CONTRACTOR tryC 5 $i u`` �ti State Lica# City Bus.Lic.# Z 2 9 1 <br /> Address Z�=�` ✓G..1 x R.( /V'. s••� c L Pa-X,)(L,A %-L--1J Phone/Email 5 3 2 12 IL's <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> al5w�w3 stt� -Yf; ��Z'� <br /> Phone/E-mail a53- <br /> BUILDING <br /> 5 -BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK Zi t2 <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building Gas_ Electric Other_ <br /> Building type: Single Family _Duplex_Townhouse —Multi-Family —00 rin rcial <br /> Type of ro•ect: New Addition Remodel Repair T.I.—Sin S rinkler Demolition Chane of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> rIS W`�JGf✓7Ix�� � h� �prrn�lcv� �^' l�ce��w`�da� `I Nom`"' GI,►n,� I��pr' <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 I 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 j 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 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 /> 0L <br /> Owner/Authorized Ag S• re Date (Revised 4/2015) <br /> t ` 3 <br />