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rt <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:i-crt� tot" Nye <br /> G se ����pp PROPERTY TAX P�t.:# ri xr [ O( <br /> LEGAL for new construction: Short Plat/subdivision Aon.) I-1fmk Lot No.M (attach copy of long legal description) "` <br /> OWNER Se+•✓61kQ tt4- %L. Homes Phone/E-mail J 25 9.65 goo <br /> Address i2i� N) i 4 oy.L' .N 100 City/State/Zip G.44(4,f-4-, r CI 20L4 <br /> APPLICANT:_Owner _Owner's I Ir,AgentLContractor _Contractor's Agent _Tenant(must provide a letter of consent from the owner to do work in the space) <br /> CONTRACTOR7MIrc� �ca) J�/ Ji ��✓ Statet-`�Lic.# L`�l� City Bus.Lic.# • <br /> • <br /> Address I ?4 2Z Pj)ck.i'/)r4 ,su' MID: 5{�oYtorn ishr fnl7/- Phone/Email 'Zr 3g q 5 100 <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT • <br /> Phone/E-mail 42654 - • <br /> b O® <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK • (d_S)/P. <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 ofUse <br /> DESCRIPTION OF WORK(additional space provided on the back):mult_h <br /> $ ' "� '1 <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 /> INumber 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 s•-ifiied 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 size• = the owner of this roperty to erform the work for which a plication is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAG. <br /> 11Z <br /> Owner/Authorize. •gent Si na re Date (Revised 9/2014) a <br /> 6 <br />