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. i2 R.MIT A,PPLICATIM <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 /> SITE ADDRESS: I, / • PROPERTY TAX# PERMIT# s, <br /> 3 f i kWet. VAac _ r "`2O3 0'3- 0,e20 O , IJ _e4 0vt)t.i. <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy oof) <br /> flong legal description) <br /> OWNER V\ G�\ 11 A Phone/E-mail K UL 4�ri ,_A l� /Io174Gi.;1 ,CO✓IA <br /> Address 1.00c 1 Seit 5)., SE ,4- Cvve,-c{, 1320? City/State/Zip <br /> APPLICANT: Owner /Owner's Agent Contractor _Contractor's Agent _Tenant(must provide a letter of consent from the owner to as work In the space) <br /> CONTRACTOR S t'f77Cz d 6.vc Gify/Y % Q71f77dN etc State Lic.#�5E471-D 408,2c 1'" City Bus. Lic.# • <br /> Address /24,1 /30 R_ c•• Ce A-- 677:42,.97-1- wsrt- 47 ' f Phone/Email 1%i,(-5/'-6#y/ -5®/}-ifi7//ae ( <br /> TENANT BUSINESS NAME / ( CONTACT FOR PERMIT 1 / cc <br /> W .Ii t / <br /> 4- 5-.--5731-64214 .. Phone/E-mail ,.9 5-AA-0 7 S'' 6-11k/L , Ca / . <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF�WORK / t <br /> Existing Use of Building /'/P ( HEAT SOURCE: <br /> • <br /> Proposed Use of Buildin• Vizi `•— <br /> • , <br /> � Gas Electric Other_ <br /> Building typ-: Single Family _Duplex_Townhouse �r 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 /> N tU f _. -A- (- <br /> MECHANICAL PERMIT APPLICATION I PLUMBING PERMIT APPLICATION <br /> Type of Project: 4ew_Addn Alteration_Repair Type of Project: jNew_Addn Alteration^Repair <br /> Show Number(#)of fixtures Show Number(#)of fixtures <br /> NC-air handling units 3 Toilet <br /> Forced air systems i 1 Bathtub <br /> Gas piping 4Lavatory(wash basin). <br /> I Water heater I Shower <br /> Gas fireplace I Kitchen sink&disposal <br /> Gas range I Dishwasher <br /> Clothes dryer I Clothes washer <br /> I Range hood Water heater <br /> 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 /> I Woodstove I Grease trap <br /> I Ducting I Roof drains <br /> I 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 /> Qom. <br /> Owner/ uthorized Agent Signature 4 Date (Revised 4/20 <br />