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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 /> Bar kSh'ire D) � <br /> SITE ADDRESS: ! 107 �.ViCr`�rcrr VC.A PROPERTY TAX# PEANUT# oM11/ <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER LAij Y egerr 9- ` ('V(x,EL Phone/E-mail 4a.6—a-57-53315 <br /> Address S -00 Cedar Sire - City/State/Zip V e K��-, <br /> APPLICANT: 17Owner _Owner's Agent _Contractor _Contractor's Agent _Tenant(must <br /> tp9150.1provide a letter of consent from the owner to do work in the space) <br /> CONTRACTOR MT State Lic.# 4" - City Bus. Lic.. 9150.1Address I Q®t, Cert Rc , Eva-sun N "A g?..41 Phone/Email Q�/jf I7U I I '(,0111ynerno <br /> TENANT BUSINESS NAME CONTACT F <br /> OR PERMIT sent Ke.7p,C <br /> /`a nrba .FOeevaG .v24 Ic�Uts <br /> omai, .OrYI <br /> PhBUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK $ DLP <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building Gas_ ElectricOther <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 /> IZepl&cc_ exlshvu��fevck-R.sevrttAR...*�3. ins�aM i"rnesin cm ttnkf-evice ( ) I�+.9 * <br /> W je&w t 12.-e00.ce SE'C *n -R C.) and secin csy1 B OLS <br /> r1 . <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 /> 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.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 /> 9` 74 /7 <br /> Cut <br /> rized Agent Signature D to (Revised 9/2014) <br /> to 107 j3 et-ksi ore Dr. <br />