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. IERMIT A.PPIJ ATI,C <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: ( f c PROPERTY TAX# PERMIT# <br /> • d6 _. ►' Lula- (bac _ ,/ �`203 op3"32.ao 0 ,o .1 11--00. .. <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER y\V� t C4 �� Phone/E-mail K UL 4 >4 it /-0 argl ,CD✓IA <br /> Address Io5 134-11't 5k SE 94- Evet f cf 202 City/State/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 S%7(3 il ✓ L 0,) 4%1777,f-naw C.LCIState Lic,# 5E)I-T7D i`Z2c I-City Bus. Lic.# <br /> Address /2-19,1 /3o R_ Si. CF i/1— C 2 ct/4-- 48 2-0 (Phone/Email AC-5-0f'G i"' " �Pr f f��1 � ��C <br /> TENANT BUSINESS NAME / CONTACT FQRPERMIT J <br /> 5.—'S`31 -6 id - Phone/E-mall .;r .-Ak(fO/r i S 0 6114--/G r Ce / <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF�WORK - <br /> Existing Use of Building AI/A HEAT SOURCE: <br /> Proposed Use of Buildin• - ..� ., L / <br /> p �r1 -� _ Gas Electric // Other <br /> Building typ Single Family _Duplex_Townhouse �r •ommercial <br /> Ili. ._ <br /> Type of project: r/New Addition _Remodel _Repair . ._ ign_Sprinkler_Demolition_Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back) <br /> N ,6-.--pu c__cF,-i/ . ___A---1,-7-46 j_ie--D <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: eaew Addn Alteration_Repair Type of Project: , New Addn Alteration_Repair <br /> Show Number(#)of fixtures Show Number(#)of fixtures <br /> NC—air handling units 3 Toilet <br /> Forced air systems I Bathtub <br /> Gas piping 4 Lavatory(wash basin). <br /> 1 ! I Water heater I I Shower <br /> Gas fireplace 1 Kitchen sink&disposal <br /> Gas range f Dishwasher <br /> 1 Clothes dryer ( Clothes washer <br /> Range hood Water heater <br /> A- f Exhaust fan I Sink(service/bar/mop/etc.) <br /> Heat pump L Backflow preventer(inside bldg) <br /> Unit heater Urinal <br /> Boiler Drinking Fountain <br /> Refrigeration Floor drain <br /> Woodatove 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 /> p).„..._ S /S---- <br /> Owner/ uthorized Agent Signature Date (Revised 4/ 15) <br /> • <br /> \) � <br />