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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:_toil.; <br /> '"1t-11 On Se- PROPERTY TAX# VVIT % i! <br /> yzo <br /> LEGAL for new construction: Short Plat/subdivision Nov kots Lot No.&12- (attach copy of long legal description) <br /> OWNER SeC Q pck2tCic Homes Phone/E-mail q25 q65 Lgoo <br /> Address �y ) eJe t •• ly iIOItiC) City/State/Zip f .J/(.2,f4r q?Zo <br /> APPLICANT:_Owner _Owner's Agent A Contractor _Contractor's Agent _Tenant(must provide a letter of consent from the owner to do work in the space) <br /> CONTRACTOR A'tX1?d p'1Gllflh//1f pJ'I,io71V)G4State Lic.# i t J 0J i-di7L City Bus.Lic.# <br /> Address I '22 Ai ckAril Thite,Su il'0: s no torn i sh.Vvf/4 Phone/Email q'ZS 3 q q 5 i 00 <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> `+.____ Phone/E-mail li 6 54 E, w 5 100 <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK ,G7 fir✓P. 60 <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): ( D/ — c: <br /> . u it 4; ..... ot, ....(/ . 451.4/ peLL4s,I/ ,nr <br /> j_t_t_it, <br /> icp <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 /> DuctinRoof drains <br /> Other q Medical Gas <br /> SPRINKLER/SUPPRESSION SYSTEM Other: <br /> aZ I 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 comps <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 authorize. 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 /> 1 <br /> 1i / 2'//z/if;� <br /> Owner/Authorized Agent Signature Date (Revised 9/2p14) <br /> �JyI <br />