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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: PROPERTY TAX# PERMIT# <br /> 32-00 22 C-1" t/,PitrU'r- q0201 ©o �5 r�' 11//I 06/6d b i.q 1 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal/a1ei adescription)/ <br /> �,OWNER (Q�r(/,7, Phone/E-mail di4c 3z'/9f6/rna hot !f7{ ,444'.[: l <br /> Address / 21 A& �f� (/Lit (9p City/State/Zip ��,�tr/Y.Iod/I/[!1[ 40 0 Yt Lf 5.6- <br /> APPLICANT:_Owwwnnrerw�1_Owner's Agent _Contractor _Contractor's Agent _Tenant(mustprovidea letter of consent from the owner to do work in the space) <br /> CONTRACTOR &eA'I il/pl 0� lot A6 e' c State Lic.#� l ji f q�City Bus. Lic.#& t1A'/qj. <br /> Address 2...9 , j} /113v f?'1344// 2,6p Phone/Email 4f z, /040/4ifIi .‘4Gtvsr{ & <br /> TENANT BUS NES NAME 1 1 CNTA R PERMIT / � <br /> Al �jes61#(3 , Vit-Ad -4JGrrS�Kedi2 <br /> 4f;r1 V I 1 11/ Phone/E-mail if 2 f 3z,y IQ 5-i <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK I leeed w :Do <br /> r <br /> Existing Use of Building / i i,,✓ yi I '.$ r' HEAT SOURCE: <br /> Proposed Use of Building/4410a Uilifi r'' .c) it, 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 W RK(additional space provided on the back): <br /> 141/ id ,1 1G-G s Fp G�,1t o i 11" V4Wal�1aid w 1rbI <br /> GQwllir/Yf fC4�i 5 c/ l <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> • <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(inside bldg) <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 /> 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 grantineof 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 a -. orize. '• , e owner. . .perty 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 /> /1/Z—/ig <br /> •wner/Authorized Agent Signature Date (Revised 4/2015) <br />