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• <br /> 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--At 12-0A-V/ PCV PROPERTY TAX# E IT y <br /> LEGAL for new construction: Short Plat/subdivision MOM "'J Lot No.,/t ( I (attach copy of long legal description) <br /> OWNER Sea 141.Q POC i ,c,\--b MOS `l Phone/E-mail q/25 95-7-3i 'Z C? /� <br /> Address(21� 5-0C-!11�(�.i�.Tf � I \i it / i'T V� City/State/Zip e Q e.-(- \mor q<J�j 2,0 4 <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 tdrckct;!(tad (�' n bjv 3jj State Lic.# �r)VP,Nt PL I-7L$ ity Bus.Lic.#OS f <br /> Address 122z e?{(,l-1 rrva , s`t�I k 0 sytovi 4' i jy�l - Phone/Email LI'2,5 31.1 5100 • <br /> TENANT B ESS NAME 1 CONTACT FOR PERMIT <br /> . Phone/E-mail 425 - g IOC) <br /> BUILDING PERMIT APPLICATION`' CONTRACT PRICE OF WORK $1410 <br /> �C3 <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): l (oC0 D.33 <br /> Ma( - uSe <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 /> I L. 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 /> —wilt ti hether speatfiedTierein or nor i he granting ora permirdoes hot-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 b e owner of this pro rty to perform the work forwhi application is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> . / i/ei:7/2\c Kir %b <br /> Owner/Authorized Agent Signature ate (Revised 9/2014) -- <br /> 1 <br />