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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: �-} �r✓ <br /> PROPERTY TAX <br /> 1-9 25 20-x^ We <br /> C tM P R e.464 + cr3 <br /> LEGAL for new construction: Short Plat/subdivision ?\ &t tt `►S Lot No.Ii t (attach copy of long legal description) <br /> OWNER Secimi4 coal G't C�`lY� S Phone/E-mail 41'2,6 155 2.,00 ,I <br /> Address 12O S'v.) e �i cl��yA, ' #jtOL7 City/State/Zip ��f�f ��r q(��t'�g <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 Mor ad plumb/44 C3'-J'e41if)(j State Lic.# At-N A/Ai yPL C1 U7L.3 City Bus.Lic.# <br /> ti <br /> Address 1W22. I ck blyd Ake Lr,Si.(/e ID, 5 no kidfn I h1 iiviA' Phone/Email LI 2.-S- 3 L 5100 <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT ! <br /> Phone/E-mail 25 '5 t�W 1 v® <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK 6_31 S <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)C420 <br /> •• os g <br /> 0/ti <br /> ( i' u 4 ._(/ )251,,t(;),/t)L-A/ <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 /> Ductin Roof drains <br /> Other Medical Gas <br /> SPRINKLER/ SUPPRESSION SYSTEM Other: <br /> 1.2 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 a horized b 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 Sig ature Date (Revised 9/2014) <br />