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Er'<MOTPPLlCATION <br /> BUIL®INN/MECHANICAL/PLUMBING/SIGN/SPRI KLER/®EVU iLITION <br /> CITY OF EVERETT PERMIT SERVICES • <br /> 3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br /> _ --SO a ill 6R 9E <br /> ,SITE ADDRESS: PROPERTY TAX# 1074W11111 5 <br /> LEGAL for new construction: Short Plat/subdivision Mk9111t M%7111t 1 11 S Lot No. (attach copy of long legal description) <br /> •OWNER Sec -Q Of"Al;.(-- ___ \o r Phone/E-mail q'Zvi. 9155 zgoo <br /> r „ r .H.. 4 q?.2.0q. <br /> ,Address �'z(.� fah.) G��(�py l�,d�\V i"I�(�li City/State/Zip �t�t1�.,2,, <br /> APPLICANT: Owner Owner's Agent X Contractor —Contractor's Agent _Tenant(must provide a letter of consent from the owner to do work in the space) <br /> Ii ; '_ <br /> CONTRACTOR y ,l,7/'J)f/ O((/j 1butai `ri-J'L 11Y`)6) State Lic.# (4-0f 1,41. Pi,(11i7L,`� City Bus.Lic.# <br /> Address 1 R_ Ai cy_Tht- 4,_,,,sulk i=r), silo fl a n i sh.fit//M- Phone/Email —O- 3q5 5i 00 <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT • <br /> Phone/E-mail 42(5 "�5 V l VDD <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF,WORK , 6 S'd p., 0O <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 /> T •e of•ro'ect: New Addition Remodel Repair T.I. Si•_n Sprinkler _Demolition___Charlie of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): 1 \C2,34 — O( S <br /> - /171M41/±i .- (it & ( 5.(-/V, ". <br /> it- I cin <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 handlin• units Toilet <br /> Forced airs stems Bathtub <br /> Gas •ipin. Lavato wash basin) <br /> Water heater Shower <br /> Gas fireplace Kitchen sink&disposal <br /> Gas range Dishwasher <br /> Clothes d er Clothes washer <br /> Ranse hood Water heater <br /> Exhaust fan Sink(service/bar/mos/etc.) <br /> Heat*um. Backflow•reventer <br /> Unit heater Urinal <br /> Boiler Drinkin. Fountain <br /> Refri•eration Floor drain <br /> Woodstove Grease trap <br /> Ductin• Roof drains <br /> Other Medical Gas <br /> SPRINKLER/SUPPRESSION SYSTEM Other: <br /> az. 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 s cited 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 a orized by the owner f this property to perform the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 298.200A WAC. <br /> 71 G'&if <br /> Owne uthorized Agent Si nature" ��/" bate (Revised 9/2014) <br />