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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: '-afr PROPERTY TAX# PERMITfE <br /> . E - --,s A i oa3 Z0o/oZ7O0 _ (I(O-OZ9 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> _ _ <br /> OWNER CIVY\\-P+ Ku taVA Phone/E-mail kV�Gt q 61YI- 04•yvv t 1,CD <br /> Address 12OC Rb "` S+ St L1 f_I A- • City/State/Zip L%�e.i- .\ 1 .. (d t zt7C� <br /> APPLICANT: Owner Owner's Agent _.Contractor —Contractor's Agent _Tenant(must provide a letter of consent from the owner to dp work In The space) <br /> CONTRACTOR ' <br /> C i' •66-1/0-7-QPPIT I1oTfi{'j/ov C State Lic.# s'"e -77.1)4 3 32 C- City Bus, Lic.# <br /> Address /2-or (30 - . _c e:it'A e.-'Y X- ( `14/k er I <br /> Phone/Email Or/ /-6 ti//Si*t/r�Mtc ae-H>i,, <br /> TENANT BUSINESS NAME 1 I CONTACT FOR PERMIT Mck>i£,(--W L(A,t e., <br /> I 15516 5-01 Ave. vvwA.o/. ri vol- %s"z6" <br /> Maher-N1da,- 6.`v c 2t 1 ,Lowy Phone/E-mail.Vi 56 _ ,,,,e-s: ' -M 1.. , c..0 °'' <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK 059, e7i-htit. h/ . <br /> Existing Use of Building V cc v. - 1,9../s-e HEAT SOURCE: <br /> Proposed Use o - _ GasElectric Other <br /> Building ty.e: ,g_Single Family -Duplex Townhouse _Multi-Family Commercial <br /> Type of prole . `ew Addition —Remodel _Repair_T.1._Sign__Sprinkler__Demolition Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): • <br /> /Hail $F - i T,d/ <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: New_Adds Alteration Repair Type of Project: New Addn Alteration_..Repair <br /> . Show Number(#)of fixtures Show Number(#)of fixtures <br /> NC-air handling units '3 Toilet <br /> . Forced air systems 1 Bathtub ' <br /> Gas piping �-. Lavatory(wash basin). <br /> i I Water heater. ( ( Shower <br /> 1 Gas fireplace t Kitchen sink&disposal <br /> Gas range ( Dishwasher <br /> 1 Clothes dryer t Clothes washer <br /> Range hood • Water heater <br /> �f Exhaust fan Sink(service/bar/mop/etc.) <br /> • Heat pump <br /> Backflow preventer(inside bldg) <br /> Unit heater Urinal • <br /> BoilerDrinking Fountain <br /> Refrigeration Floor drain - _ <br /> Woodstove Grease trap <br /> 1 Ducting Roof drains <br /> I Other Medical Gas <br /> SPRINKLER I 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 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 forwhich <br /> ' ch application is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> ��— — <br /> iwnerlAuthorAgent Signature - � Date (Revised 4/2015) <br /> • � ' <br />