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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 AD2C , PROPERTY TAX# PERMIT#DOWCACU"n KC. EVEILIT b.p& <br /> b1<D6"0 <br /> LEGAL for new construction:rShort Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER Bon 1 v& `t Phone/E-mail <br /> Address FO �� 3101 NIS u�'�"B City/State/Zip c€i 1 Ir LL, WA iZi--220 <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 /i j (/ '",2t State Lic.#$ /jig 5I/13/A i City Bus. Lic.# L/L/3 <br /> Address 22 Ye/c ,4✓N 1444 Phone/Email 20Cp r — <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> / /> » DC�A`i 9 AS-235'01i 42 <br /> Phone/E-mail pff f. G <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK CQCII125O r-- <br /> Existing Use of Building lvtFC HEAT SOURCE: <br /> Proposed Use of Building M f& 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 <br /> �x�vfrl /o vj back): <br /> " L172er✓C�T ei=j�{,c14Sq' <br /> v-f do/f1 <br /> f'7 y " ► • .iVrt • <br /> i:76/1/d1r t,•C'�ts�a �� --�f / �r/�v,pi.-rcyi( <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 <br /> I ) Clothes dryer Dishwasher 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 --.-Float:drain .. :,.' <br /> Woodstove Grease trap <br /> Ducting Roof drains <br /> Other Medical Gas <br /> SPRINKLER/ SUPPRESSION SYSTEM Other: <br /> Number of Heads i 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 complied <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 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 /> Owner/Authorized Agent Signature Date <br /> 9 9 (Revised 3/2013) <br />