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. ' f <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: 11 20-t � ftV C �� �l PROPERTY TAX# P IT 0 r <br /> LEGAL for new construction: Short Plat/subdivisiionn mol tie 1tS Lot No.m 51 (attach copy of long legal description) -0( <br /> ` <br /> OWNER SectilkQcriLeA c. Homes S Phone/E-mail q 25 9'65 L 0 <br /> Address 12Q 'v j 1 _ t ,"�'t1t<1�,1lt Ai;I City/State/Zip J�r.2 +, WV_ q c_o <br /> APPLICANT: Owner _Owner's L%/ C'Agent X Contractor _Contractor's Agent _Tenant(must provide a letter of consent from the owner to do work in the space) <br /> CONTRACTOR a pI&/n�13 J'jc � <br /> Tin <br /> i ` State Lic.# ( p" pL'1i7L5 City Bus.Lic.#1052 g <br /> Address i k22 Kcit„C)Si!J( Priu,Sii/k ID: 5 Mina-nicht Ina4- Phone/Email q c 3L 5 100 <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT • <br /> ��.„.............._ Phone/E-mail 42,5 '514 R W 5 V D® <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK p 6___SL3 <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): 1110G, CD <br /> Ott I_fi ,_ R5,6, -(1 iti__ 51,treci4s/ --11 <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New_Addn Alteration_Repair Type of Project: _NewAddn _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 /> az I 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 I am au zed; the owner of this pr%•ertyytto perform the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> 04/1--g /-z/z/4, <br /> 0 --r/Authorized Agent Signatur=� D (Revised 9/2014) <br /> 6/_2_____ <br />