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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: n ce. R <br /> PROPERTY TAX it <br /> 1� Oper" t'(] G� <br /> W 1 "1�/ "In5 <br /> LEGAL for new construction: Short Plat/subdivision MV1VIt i 1r Lot No.0 l.01 (attach copy of long legal description) <br /> OWNER% 14th Pc(c f i c.t\ 5 Phone/E-mail ,'2rj (a�Cj S ) <br /> ?SC <br /> Address 121 so /24e ltZ{-1-VVVi 4( \/ �J- (lop —�City/State/Zip I v e �T► ( pr a iS 2,0 4 <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 ilr tc ',(/Lea <br /> O tt rn 191 ii13; State <br /> Lic.# A 'L�I-7L <br /> �ity Bus.Lic. <br /> Address bG2 6ist„.6Oa , J(1I).e0SV1Vn4rs ht Phone/Email q‘2,6 31f <br /> 5 j co <br /> TENANT BUSU ESS NAME CONTACT FOR PERMIT <br /> �--� Phone/E-mail 425 t<I MOD <br /> O D <br /> BUILDING PERMIT APPLICATIOI CONTRACT PRICE OF WORK $'-t /7. 00 <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): t r _ ,N <br /> /110E1 <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 /> NC-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 /> 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 comp) <br /> with whether specified herein or not I he grantingora permit does-notpresume-togive authority to violate or cancel the-provision of-any-other state or local law regulating-construction----------- <br /> That I am a orized 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 /> A115 Z-// <br /> Owner/Authorized Agent Si ature ` Date (Revised 9/2014) <br /> f . <br />