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• <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: `11 'lLI' b n ce PROPERTY TAX# P R T t,- 64 <br /> LEGAL for new construction: Short Plat/subdivision MIMIC `1C tVIIII5 Lot No.QU} (attach copy of long legal description) <br /> OWNER Se 1 cak,jc (_ Homes Phone/E-mail J 25 (16 ) .goo <br /> Address 1'20 SvJ - °( 1t,\yia City/State/Zip �J (���, wi4 q 52.0 <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 Mui id ppI(,�j7gb!/ P iteoho j State Lic.# At-2,1,A")0.,09131.5 City Bus.Lic.# <br /> Address I ?2Z i ciaor Q Ake,sulk k ; 5 no darn ishr lnst4 Phone/Email qts- 3W 5;00 <br /> 00 <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Phone/E-mail 42,6 — — b iOO <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): C‘ / O/ 057_ <br /> 1.11 (iteS,& &L. C/V et—LA/ <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 /> 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.y 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 /> n640,14,1 /Z /Je /1 <br /> Owner/Authorized Agent Sig ature Date (Revised 9/20 <br />