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11:'ERMIT APPLICATIN1 <br /> BUIL DIN IMECHANICAL/PL.UMBING/SIGN/SPRINKLER/DEM L,ITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa,org <br /> SITE ADnRESS: i I PROPERTY TAX If PERMIT • F; <br /> • L l .ule,i. Ptac-e - ' s's 203 .rs3"3 aofa '10 ell I .—a 1 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER V\1(Vve4-- ice' `J c",&A Phone/E-mail KU LAI-tlf&,..,A6'I404-IA&u\ ,(o✓v <br /> . . <br /> Address 12'5 13'97 1,1 51., sE 94- C ce , c3 ? CityiState/Zip <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 S75 ôCgG12/�,Yi'r�✓%4 Q77,f17d t/ L1-��C-JState Lic.#/(ZS6 628 2C l—City Bus. Lic. <br /> Address /2.o[ /3o S-1. CF ,i- ��-y r2. 7 ` cv- 48 2.-0 f 1Phone/Email15f6# / '5 hottivis®6`(1( <br /> TENANT BUSINESS NAME / ( CONTACT FQR PERMIT cc <br /> /i 7r <br /> iC-- <br /> 5-Sal.--6,A - Phone/E-mail ..r .51A-11-0/`Z u.5 fp 6- <br /> H /L r Ca 1 ' <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OFWORK , <br /> r <br /> Existing Use of Building ///rig t, HEAT SOURCE: <br /> L- O <br /> Proposed Use of Buildin. fr/E471-1` go..�� /1.) Gas_ Electric f/ Other <br /> Building typ Single Family Duplex Townhouse ilaigralio4 ommercial <br /> Type of project: ,/New _Addition _Remodel _Repair . . Ign_Sprinkler_Demolition_Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back) <br /> NE-t ,Sr—,-/k_ _A— &—D <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: ew Addn Alteration_Repair Type of Project: ZNew_Addn Alteration,__,.Repair <br /> Show Number(#)of fixtures Show Number(#)of fixtures <br /> A/C—air handling units 3 Toilet . <br /> Forced air systems ) Bathtub <br /> Gas piping 4 Lavatory(wash basin). <br /> I Water heater 1 1 Shower <br /> 1 Gas fireplace I Kitchen sink&disposal . <br /> Gas range ( Dishwasher ' <br /> I Clothes dryer l Clothes washer <br /> Range hood Water heater <br /> A- I Exhaust fan I Sink(service/bar/mop/etc.) <br /> Heat pump Backflow preventer(inside bldg) <br /> Unit heater Urinal <br /> Boiler I Drinking Fountain <br /> Refrigeration Floor drain <br /> Woodstove I Grease trap <br /> Ducting I 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 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 auth ri ed by the owner of this property to perform the work for which ap lication is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> Owner! uthorized Agent Signature Date (Revised '015) <br />