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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 /> C(4) 1 Lfp 8-001.1 <br /> SITE ADDRESS: PROPERTY TAX# PE I • <br /> °797E25 r.10/2•1"614 / SVOILVIT [�J�I�i1 51$100 00r, ► <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER 11/ 4 1TlIVVV Gj •L ' MG'j)N N Phone/E-mail L 4 ^g16-.2,2,g1 <br /> Address 20705 1•1O0--rON City/State/Zip OV/ 'jt/ INA '9 44 <br /> APPLICANT: 1( 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 State Lic.# City Bus. Lic.# <br /> Address Phone/Email <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> *00-1yl- -41+1td- <br /> Phone/E-mail !74'y4iiO.ytingktint AiI. whet <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK 1,5/0170 <br /> Existing Use of Building r44»OW 11 dl., HEAT SOURCE: <br /> Proposed Use of Building t2" b 1.04, 02'• Gas X Electric_ Other_ <br /> Building type: ,e Single Family _Duplex Townhouse _Multi-Family _Commercial <br /> Type of project: _New Addition _Remodel X Repair_T.I._Sign_Sprinkler Demolition Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> t 1't.VMM O T nikM" 12 IZoOP 64JV 124r4112. Al4 P M tits-f op i J64'P,iT WOt/v4 t wA,v1911.3& b�I�/ti,d�4,012 <br /> fie.p4 1'J&, lw v WcT to t4 Act.i b PIN I SS Noemp-ort <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 /> j A/C—air handling units 1 ( Toilet <br /> Forced air systems 1 j Bathtub, <br /> Gas piping t j Lavatory(wash basin) <br /> 1 j .Water heater 9 j Shower <br /> Gas fireplace t j Kitchen sink&disposal <br /> Gas range j Dishwasher <br /> j Clothes dryer 1 j Clothes washer <br /> 1 Range hood <br /> 3 j Exhaust fan t j Sink(service/bar/mop/etc.) <br /> Heat pump I Backflow preventer <br /> Unit heater j Urinal <br /> Boiler j Drinking Fountain <br /> Refrigeration j Floor drain • <br /> Woodstove ; Grease trap <br /> j Ducting j Roof drains <br /> Other I Medical Gas <br /> SPRINKLER/SUPPRESSION SYSTEM Other: <br /> Number of Heads j 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 lam 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 /> • <br /> t91/1'49/1 <br /> Owner/Authorized A t Signature Date (Revised 3/201.37 <br />