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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 /> f'2o3 Gw14 z - <br /> SITE ADDRESS: PROPERTY TAX# PE MIT <br /> 501 S S A(/ Jer f a p f'm3tiz 7C 0 1310 -003 <br /> LEGAL for new construction: Short Plat/subdivision Q(v yj frf 7iL At-11 i Lot r '' aicgiy of long legal description) t/ <br /> OWNERc\9-t(Ld pstituv(e-&, c1„,c!-,„4.0 , Phone/E-mail14_IDYD OS6 C Q(plta-.yAt i 'a."t <br /> Address7 <br /> )(3 SIIP A(m 'e7 p //,f2 )f City/State/Zit4/ixt g�?n3 <br /> APPLICANT: Owner _Owners Agent> 4_Contractor _Contractor's Agent `Tenant(must provide a letter of consent from the owner to do work in the space) <br /> CONTRACTOR O' `JA_., State Lic.# City Bus. Lic.# <br /> Address Phone/Email <br /> TENANT BUSINESS NAME CONTACT FOR EgMI <br /> Phone/E-mail: i —to / CSLP/IACC C_.. • <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of Building _90,- � w1 fl (L HEAT SOURCE: <br /> Proposed Use of Building 0 VI/IPA— Gas Electric_ Other <br /> Building type: x 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): / 1. �eGe l`e€ce, 00/'./l`�'4" %) <br /> AJS A--eGDQI 0z9-'` ofit im✓S ISN~-(4- <br /> p„..4,,,0_,5,4 4__ <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New.Addn XAlteration_Repair Type of Project: _NewAddn _Alteration_Repair <br /> Show Number(#)of fixtures Show Number(#)of fixtures <br /> A/C—air handling units ` Toilet <br /> Forced air systems J I Bathtub <br /> Gas piping k// Lavatory(wash basin) <br /> Water heater �// Shower <br /> Gas fireplace Kitchen sink&disposal <br /> Gas range j Dishwasher <br /> j Clothes dryer J Clothes washer <br /> Range hood Water heater <br /> Exhaust fan Sink(service/bar/mop/etc.) <br /> Heat pump. I Backflow preventer <br /> Unit heater l Urinal <br /> Boiler Drinking Fountain <br /> Refrigeration i Floor drain • <br /> Woodstove Grease trap <br /> Ducting Roof drains <br /> Other _ Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM I Other: <br /> Number of Heads I 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 b the owne of this property to p-••rm the work for which application Is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> ar <br /> 4 <br /> Owner/Author's A. nt Signature Date (Revised 3/2013) <br />