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PERMIT APP ICATION <br /> BUILDING/MECHANICAL4PLUMBING IGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett,W 9 201 425-257-8810 FAX 425-257-8857 www.everettvva.org <br /> /�D W O ih i Ti4' 1P4(90( <br /> SITE ADDRESS: PROPERTY TAX# PEW # <br /> 1 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER ti706 Phone/E-mail <br /> Address b ( �, 5 j„�o 45. z. City/State/Zip <br /> APPLICANT:_Owner _Owner's Agent x Contractor _Contractor's Agent _Tenant(must provide a letter ofconsent from the owner to do work in the space) <br /> CONTRACTOR MC\ tncr)(V\ State Lie# tAC Lei 4k Wt> City Bus.Lic.#65122 <br /> Address G3OOS 3? PJ b S/con-RA-Loa OM 34 Phone/Email <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> �',it ✓* -..G <br /> � \ ' A <br /> y\ Phone/E-mail i �� r t c h:•ti S r . C o <br /> BUILDING PERAPPLICATION CONTRACT PRICE OF WORK 4 <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building t e 5 A c rf ' , . Gas Electric Other_ <br /> Building type: _Single Family _Duplex To nhouse Multi-Family _Commercial <br /> Type of project: X New Addition Remodel Repair T.I. Sign Sprinkler Demolition Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> INSTp►woT10N 0latigiLA,p.No4W1J`4,wiv► <br /> ��► r• NEW 1-kuA \ QSP 1 %aro txr•4 V-01- P7OtVb1 - <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 • �j 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 /> igagpolw Ducting 10 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 spec) -. 1'rein or not.The grant' •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 aut . ed• the owner of t�gratify <br /> 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 /> 44,306 <br /> Owner '"o tze• Age ignature Date (Revised 4/2015) <br />