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PERMIT APPLICATION <br />BUILDING/MECHANICAL/PLUMBING/SIGNISPRINKLER/DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 WvrW.everethva.org <br />�— <br />SITEADDRESS:PROPERTY <br />20 t $ E� �fL q i `1 L71 <br />TAX <br />PERMIT# -7 <br />n0 - i7 '7 <br />LEGAL for new construction: Shod Plat/subdivision_ Lot No.__ (attach copy of long legal description) <br />OWNER <br />lh lP'-5LO JtU SCUA -Lui <br />Phone/Grua)) $C--�tn� I.s1� <br />,s,^ M�.r r� I , <br />Address I s �00 D t I in) t N� M <br />CitylStatelZip •{-� C/t�+�t,1 lv� ��t 55 <br />APPLICANT: Owner Owners Agent _Contractor _ Contractor's Agent —Tenant (must pronoo a letter of consent vim the mmrto do Rork in the space) <br />CONTRACTOR S V t <br />State Lic. # City Bus. Lic. # <br />Address Phone/Email <br />TENANT BUSINESS NAME <br />Q S n0 t <br />CONTACT FOR PERMIT <br />t� <br />Phone/E-mail oL, ^17310-h1 <br />BUILDING PERMIT APPLICATION <br />'3 <br />CONTRACT PRICE OF WORK -ISO GD <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.J. _Sign _Sprinkler _Demolition_Change of Use <br />DESCRIPTION OF WORK (additional space provided on the back): _ <br />(,,,AS +tit-oNJ'& Firvo <br />MECHANICAL PERMIT APPLICATION <br />PLUMBING PERMIT APPLICATION <br />Typo of Project: _New_Addn _Allerat:on_Repair <br />Show Number (#) of fixtures <br />Typo of Project: _Now_Addn —Alteration _Repair <br />Show Number (#) of fixtures <br />AJC -air handling units <br />Toilet <br />I Forced air systems <br />Bathtub <br />Gas piping <br />Lavatory (wash basin) <br />Water healer <br />I Shower <br />Gas fireplace <br />Kitchen sink & disposal <br />Gas range <br />Dishwasher <br />t Clothes dryer <br />Clothes washer <br />Range hood <br />Water heater <br />Exhaust fan <br />Sink (selvice/bar/mopletc.) <br />Heat pump <br />Backflow preventer <br />Unit heater <br />Urinal <br />i Boiler <br />Drinking Fountain <br />I Refrigeration <br />Floor drain <br />Woodstove <br />Grease trap <br />Ducting <br />Roof drains <br />Other <br />j Medical Gas <br />SPRINKLER I SUPPRESSION SYSTEM <br />Other: <br />Number of Heads <br />Other: <br />I hereby cendythat I have read and examined this application. Ind know the same to be true and correct. All provisions of laws and ordinances governing this type of work win be complied <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 />Thal I am authorized by the owner of this property to perform trio work for <br />which application Is made and 1 comply with the Slate Contractors Law 18.27 RCW and 298.200A WAC. <br />� A <br />O - <br />Ownor riho ' ed Agent Signature Date (Revised 312013) <br />!M <br />