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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 514 <br /> Z.mLL?- MI L00(0®® <br /> SITE R !: PROPERTY TAX EIT# <br /> --7gw!0l0SLFtFIe gl. ()8OT7( ) <br /> LEGAL for new construction:coShort Plat/subdivision�p 1 t/'Irb J Lot No.) (attach copy of long legal/aldescription) <br /> OWNER ( 7l �/l �c. H b t 1 e C Phone/E-mail �-i s-q 1/i,�.Address i ()1 s W 1 fey nil) upi City/State/Zip 9 iejj goo(' <br /> APPLICANT:_Owner _Owners Agent Contractor ) Contractor's Agent _Tenant(must provide a letter of consent from the owner to do work in the space) <br /> CONTRACTOR P1)Cr+ viect-1-1119 State Lic.#page1tIfa () City Bus.Lic.#1�1 lap <br /> �`` 1 �,�n `�pn vu,c /� �'Xr' <br /> Address 00 1�.1(.. i L.(1l S V 5 ) ,4 of ,W Phone/Email <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT L I�/5� e 1 f ,5 <br /> Phone/E-mail Li 2,s3344-�y l I <br /> BUILDING PERMIT APPLICATIONj� CONTRACT PRICE OF WORK (f O 5 --' <br /> Existing Use of Building 5+ HEAT HEAT SOURCE: <br /> Proposed Use of Building S 7 R Gas _ Electric Other <br /> Building type: _Single Family _Duplex Xownhouse —Multi-Family _Commercial <br /> Type of project: New _Addition _Remodel _Repair T.I._Sign_Sprinkler Demolition Change of Use <br /> DESCRIPTION OF WORKadditional space provided on the back): <br /> In5Jd 11 cduc, less iw f mini 10/in a irda , h <br /> enc' I OtAi-d6Dk Gr n, <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 •ein 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•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 /> � ivy / LI-24)1--,Owner/Au ,'•rued Agent Signature Date (Revised 9/2014 <br />