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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 /> SITE ADDRESS: 13143 I►'ta a Apz, �v PR 6°TY 5`�eoza .331J3 ` I' o -o1) <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER & 7� ppQQ5-- c Q Phone/E-mail S.4-.6t(k.�]�'�1 OW/ Z-40" <br /> zZ-40"Address )3Li 3 ✓vlLtyfv <br /> Cr17�, Av e- City/State/Zip �V¢r¢}!) I A <br /> APPLICANT: Owner _Owner's Agent Ki Contractor Contractor's Agent _D Tenant(must provide a letter of consent from the owner to do work in the space) <br /> CONTRACTOR Oa,( SA �v�,�}'Yt)��}pS�+� t., State Lic.# Cie L)76-mo City Bus. Lic.#V-towgil <br /> Address 5 sW �Ue -' i �1� 161,611 Phone/Email q25-792.- 7532, <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> 1125-792- 1532 _ <br /> Phone/E-mail G,�w}a @ Lam fdS?rt•7tZl Z zv�/.Le-dinr- <br /> c. <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK ?0/OCS .- a <br /> Existing Use of Building S F R. HEAT SOURCE: <br /> Proposed Use of Building t n6tc� .i Gas_ Electric_ Other_ <br /> Building type: ,4.Single Family o Duplex_Townhouse Multi-Family _Commercial <br /> Type of project: New Addition Remodel Repair T.I. Sign Sprinkler Demolition Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> A-1(nGt.Rr,oLYr Gu`� SLl� Skittf g OA't 5 'R , <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 /> A/C-air handling units Toilet <br /> Forced air systc s Bathtub <br /> Gas piping Lavatory(w.sh basin) <br /> Water heat: Shower <br /> Gas firep •ce Kitche ink&disposal <br /> Gas ra •e Dish,asher <br /> Cloth= dryer CI. es washer <br /> Ra •e hood ater heater <br /> E aust fan .ink(service/bar/mop/etc.) <br /> eat pump Backflow preventer <br /> Unit heater Urinal <br /> Boiler Drinking Fountain <br /> Refrigeration Floor drain <br /> Woodstove Grease trap <br /> Ducting Roof drains <br /> Other Medical Gas <br /> •RINKLER/ SUPPRESSION SYSTEM Other: <br /> Number of Heads Other: <br /> 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 comp) <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 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 /> . `1/415 <br /> Owner/Autho' e9'Agent Signature Date (Revised 9/ • • <br />