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PERMIT APPLICATION <br /> BUIL DINGIMECHANICALIPLUMBING/SIGN/SPRINKLERIDEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 cedar St., Everett,WA 98201 425-257-88W FAX 425-257-8857 www.everettwa.org <br /> SITE ADDRESS: PROPERTY TAX# PERMIT# <br /> 70,32 cl s lir, c2O j (ac 'Qo 10Z I <br /> LEGAL for new construction: Short Platisubdivision Lot No. (attach copy of long legal description) <br /> OWNER}}' ►y`t " �.�' ele PhonelE-rnail 172 - <br /> Address..! 2„ t' 'Ad 4. city/StatetZ pelyireif t,'/ i2A-`F <br /> APPLICANT:_Owner Owner's Agent _Contractor'."` Contractor's Agent , 'enant(most.pmvide a letter of consent.horn the owner to do work in the space) <br /> CONTRACTOR 1361 j 5-)(oil'6,4c State Lic.# EC-(ZE'erS rigacity Bus.Lie # vtiz88 <br /> Address lb 1 2):,, 7-11 i p`-`t'+tov t 1-0 f c`"1 —. `hone/Email : r3* , 7 i QI <br /> TENANT BUSINESS NAME CONTACT FOR PERMlyithAtittic..,,12 ,ThiIT <br /> t Le' <br /> Phone/E-utast 1.42-c-1-143[' 3`5-3 5 <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> --. I <br /> Existing Use of Building __ HEAT SOURCE: <br /> Proposed Use of Building 1 Gas Electric,_,. Other_ <br /> Building type: _Single Family Duplex Townhouse r Multi-Family Commercial <br /> Type of project: New _Addition _Remodel Repair T.1. Sign, Sprinkler Demolition_Change- of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> . 4 .y_. 4\r- ,,,d,,t natt 41c.kcitz_L roil\ i--- <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: New_Addn ,',Alteration Repair Type of Project New Acldn Alteration Repair <br /> Show Number(#)of(ixtureS Shote Number(#)of fixtures <br /> A/C-air handling units Toilet <br /> x Forced sir 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 <br /> Backflow prevetiter <br /> Unit heater Urinal <br /> Boiler Drinking Fountain <br /> Refrl•eration Floor drain <br /> Woodstove Grease trap <br /> Ducting Roof drains <br /> Other Medical Gas <br /> SPRINKLER l SUPPRESSION SYSTEM Other: <br /> Number of Heads Other. <br /> I hereby certify that I have read and examined this application and know the sante'to be 1nie and comet.All provisions of laws and ordinances governing this type of work will be comp!' <br /> with whethe 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 taw regulating construction <br /> .,.11a Kthonzed by the own this. •petty to perform the workfor which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAG.. <br /> 000, <br /> /Authorized A n r <br /> ge t Signature to (Revised 9/2014) <br />