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4. <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 ADDRESS: o5 fl ill D� Sr PROPERTY TAX# Tot'(q3.4 7 <br /> LEGAL for new construction: Short Plat/subdivision 1\-1911'M I kUlo)ts Lot No.?!Q j (attach copy of long legal description) <br /> OWNERe ("!S�( 4I Pact oS Phone/E-mail i[2,5 615.2) 2.2c0 (��7 <br /> Address 12D JVJ -,'.4V1✓�4l1 \,\_\6 - IOD City/State/Zip Cve(.e-k', \Arp ('�-` rJ 9J 4 <br /> APPLICANT:_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 / aced p'��} l3 State Lic.# f+t)V) PJ PLg, -]Lsity Bus.Lic.# : <br /> Address i gzz 6itif Ji of pro,/ , l,�l e 0, Sy.UY Loos h1 mi_ Phone/Email q' j 3LI R 5100 . _ • <br /> TENANT B ESS NAME CONTACT FOR PERMIT <br /> Phone/E-mail 425 S Lig 500 00 . <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK $ 41/7.CO <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.I._Sign Sprinkler Demolition Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): CA(vIGG„0 Co r�y <br /> �/`"C <br /> 41 a 01 ' . rt re, <br /> U <br /> YepPan`_� / <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 /> • <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 <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 /> IL 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 /> wTtFw to her specifi d herein or not:The grading of a pemtirdoes-notpresume-to give`authorityto-violate-orcancel theprovision-ofany-otherstate-or-local-law regulating-construction------------ <br /> That I am67 <br /> jauth. ed by the owner of this property to perform(/'the work for which application ismade and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> �!' .---- /, ° /2///2//6 <br /> Owner/Authorized Agent Signature l� Date (Revised 9/2014) <br />