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11 ! � <br /> 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 /> ISITEADDR <br /> \s{ � ° PROPERTY TAX# <br /> It11402.' <br /> + 01 <br /> LEGAL for new construction: Short Plat/subdivision \i---kik\� d\� Lot No.rt(attach copy of long legal description) <br /> ' 1 <br /> OWNER �(/�0a C. `��/���1�� �,P�h�o�ne/E-mail '-'1 S' 4��'�-{ y Li <br /> Address VA `V`\ hr 1 t\( k. ��-QV.I �°\VCi 1tate2ip —!/v _t(,'e Na 1 SAD ' -2_,,,.. <br /> APPLICANT:_Owner _Owner's Agent X Contractor _Contractor's Agent Tenant(must provide a letter of consent from the owner to do work in the space <br /> CONTRACTOR \ ' b QS C ?.V h tate Lic.# C 1 \ (QCity Bus. Lic.#60-735 <br /> Address V\Q !7 0..\ 1 A c...-&.)— � °\`v \\YN� g(QC)`-�b�' <br /> �Z,Z Phone/Email V U <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Phone/E-mail <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK '3S 1 O -CP-1-- <br /> Existing <br /> CP-1--Existing Use of Building HEAT SOURCE: <br /> Proposed UseofBuilding 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): <br /> �'N Com%C J\c, � v- %c Yt (ivim.v <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New_Addn Alteration_Repair Type of Project: _New_Adds 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 /> r 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 /> t 1 Number of Heads Other: <br /> I hereby certify hat 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 corn 3, <br /> with whether- ecified 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 constructio ij <br /> T I a a ed• • •.--y 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 /> ilk <br /> ._� , -VICl <br /> g <br /> Owner/A horid Aen , .ature Date 7 \ (Revised 92014) <br /> 1 �' <br /> wX <br />