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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: .y Vn �n On �n ce (PROPERTY TAX# IL# t 621 <br /> LEGAL for new construction:�- 1Short Plat/subdivisioniot A►l11{ �` J Lot No.'fD tp1 (attach copy of long legal description) <br /> OWNER SeC ,i,c{ ,^ Phone/E-mail J 2,5 R5 5 .z goo ,I <br /> Address i'2Q SV°J �)e �. "1` 1�1V ''4 1 io City/State/Zip tf tr-t. , + lir q�z0` <br /> APPLICANT:_Owner _Owner's Agent '�')'1-L 1Y)! 'Contractor _Contractor's Agent _Tenant(must provide a letter of consent from the owner to do work in the space) <br /> CONTRACTOR Ad ` d pI( )rki g, State/_ Lic.# atj 'Lc1 7L$ City Bus.Lic.# <br /> Pike b <br /> Address IW2.2. At rt aide ID svoj'`dml vlrlilld� Phone/Email 1125 3gq 57100 <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT • <br /> Phone/E-mail 42 5 VD() <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <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): ( o( <br /> —OS <br /> Mu I (j(3,& I I — 5 ja f9"/V— S <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 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 /> 2 ( 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 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 e 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 /> e./14 //40f 777"1 <br /> Owner/Authorized Agent Si. ature Date (Revised 9/2014) <br />