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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: 1-cb D M DV- S PROPERTY TAX# �L P �#` ui ....003MI <br /> LEGAL for new construction: Short Plat/subdivision tJ'� -~ Lot No.TG Z-7 (attach copy of long legal description)1n <br /> OWNERS( t14,Q. pa -\ AOS (, J Phone/E-mail 1-1 (: 5.7) <br /> Address rip '.J 2— j �� Cl .( WC'LQ- 100 City/State/Zip e Ir e-f#1 \N`fn. q ,c 2nf . <br /> APPLICANT:_Owner _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 MO)rad p\iim bi VI 1'3\VC1 hin State Lic.# /rovAi\I po 17CScity Bus. Lic. . g <br /> Address W2.2 Cn 3((.r,UrA f 9(f c ! snot/0006k J v' 4Phone/Email /41,5 3-1 <br /> g 5 j t)O <br /> TENANT B• ESS NAME ' CONTACT FOR PERMIT <br /> • <br /> Phone/E-mail 425 cJ g 5OD <br /> BUILDING PERMIT APPLICATIONS CONTRACT PRICE OF WORK $ x-7/7• 00 <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 of project: _New Addition Remodel Repair T.I. Sign Sprinkler Demolition Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): -0 <br /> s e <br /> (g <br /> ma(-11 use 5-)L,( ppress, <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 air systems 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 <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 compl <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 lam 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 /> /76A-?-7 r77 :?//)? <br /> Owner/Authorized Agent Signatu a Date (Revised 9/2014) f <br />