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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# PE M <br /> T12. ori �p�/� q-(-)0� <br /> LEGAL for new construction: Short Plat/subdivision POtv\Q. tVvt Vit.( Lot No.f2: (attach copy of long legal description) <br /> OWNER J(rli`RSL + C(C(h i 't«nAOS f i� Phone/E-mail LI i 5 961) 'l QZ�0 <br /> Address i, U .S\J �-!U�fb �T \1\,..)06.1-1-14 !O( City/State/Zip ( ie(42,+k- \Afft q c2,04 <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 il-rUi 1Cfl.(.K (���a{��'iii GIS c , l-Rey) State Lic.# i rl)V ANI PL 1 I ]f(pity Bus. Lic.# <br /> Address(b GL P?((.�%CU�JIprkki2,r $L11 fJ °; S�f(J Y t(�%U�(j(/tt (/1/ Phone/Email LI` ,5 31-1R 5 WO <br /> TENANT B• - ESS NAME CONTACT FOR PERMIT <br /> Phone/E-mail 425 ` 6 5 OD D <br /> BUILDING PERMIT APPLICATION`' CONTRACT PRICE OF WORK $ Lf f 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): ci r c1c4^O/� <br /> • <br /> 1 <br /> I n� ` <br /> (/ — USC--) _5u()press/ <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 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 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 /> //,Owner/Authorized Agent Signature Date (Revised 9/2014) / I 1 <br /> Z <br />