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• <br /> 41111 <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 AD E S' 4 j I�PROPERTYTAX# PF�2MIT# <br /> off' w e�sia�o �.v EU ���1 f ` I <br /> LEGAL for new construction: Short Plat/subdivision 11 ►3 L D� 45-12- Lot No. (attach copy of long legal description) <br /> OWNER 136Eitst& Phone/E-mail WA tc7 <br /> Address PO Mi X101 11 I S OR--13 City/State/zip S"EM1 FLE.. r 1211--220 O 7 <br /> APPLICANT:j 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 //Ofph'► rjonrS'•T7ZrJG7'7Gba State Lic.# 1 brGML;e.,t(4-t.t C. City Bus. Lic.# 04 1.705- <br /> Address Phone/Email <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Diklri EA,4 5- -0ii'2 <br /> Phone/E-mail ,E,Fictk,�- G. DR '(I Lij6 M , <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK 24)315-, De <br /> Existing Use of Building MFS HEAT SOURCE: <br /> Proposed Use of Building M FCS Gas Electric Other <br /> Building type: Sin le Family _Duplex_Townhouse Multi-Family y Commercial <br /> Type of projec Ne Addition _Remodel _Repair_T.I._Sign_Sprinkler_Demolition_Change of Use <br /> DESCRIPTI N OF WORK(additional space provided on the back): epic).i 5„-014. /CC!,014 .e. P. <br /> 45-12- .7%"IX .5ij9TI C '7 r 'Qjt P /.f 6 6 4.I)r/L)Cil-6L) v¢• A , r,2vL'�i. - S174-4z,L3i.A <br /> CO/Pa/Lao oN A s'/'/',eiitA / 4T/ '73 ',e01/0E S7i Ailz- C.ditilble ("Q LALI"ieca i <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 /> I A/C-air handling units_ I Toilet <br /> I Forced air systems ' Bathtub <br /> Gas piping Lavatory(wash basin) <br /> Water heater I Shower <br /> ILGas fireplace Kitchen sink&disposal <br /> Gas range Dishwasher <br /> Clothes dryer Clothes washer <br /> 1 Range hood I Water heater <br /> Exhaust fan Sink(service/bar/mop/etc.) <br /> Heat pump Backflow preventer <br /> Unit heater I Urinal <br /> Boiler I 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 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 /> That I am authorized by 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 /> /19 4/1s- Y2— <br /> Owner/Aut • ize. •g nt Signature Date (Revised 3/2013) I <br />