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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: `Z 2 O,r� �V PROPERTY TAX# E IT <br /> no,-+_ DI co <br /> LEGAL for new construction: Short Plat/subdivision mom mots Lot No5i-1 (attach copy of long legal description) <br /> OWNER 9E6 PC ( - j \ , Phone/E-mail 4 25 1.15-z) ' ) <br /> Address 110 JVJ c N e M++Ni-vi I I \, k.1- 10D City/State/Zip C v e(.€14-t \A/YD' CI 204 <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 MO phial hi v1 ;3 V %t+4,1 State Lic.# /hVANI PL' I 7L$ ity Bus.Lic.# <br /> like <br /> 'n ( to —1 t <br /> Address i g22 P7j(�",61�,a f S�r K 0 t Si�U rants j kit 04+ Phone/Email Lt`7iFj 3i1 S ioo <br /> TENANT B ESS NAME CONTACT FOR PERMIT <br /> Phone/E-mail 425 tJ 4 g 5 IO <br /> BUILDING PERMIT APPLICATION_ CONTRACT PRICE OF WORK $14111• oo <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): <br /> C ` q. IL <br /> i�' "A r r�� (, <br /> ~ P©l0 Gt. /� `7 <br /> a 01 '-' use. .are <br /> vt <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 Li 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 av et tF ersr led-Wein ornot Tfie granting of-a-permirdoes notpresumeto give authority to-violate or cancel the provisiorrof any-other state-or-local-law regulating construction <br /> ThatI am a ,..ri ed•'t -owner of thisrr�erty 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 /> / fira t Z-`/Z/A, <br /> Owner/Authorized Agent Signature Date (Revised 9/2014) <br /> 1 <br />