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If . <br /> ERMIT APPLICATIdIV <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: PROPERTY TAX IlE IT# <br /> `701(Q 3ex€.0) gtv8 , g've e.4-d-, Lo 98263 o 392800 1 o o-7oO C,6 3 -OO ) <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER-77-0/ ,&.C`t� Phone/E-mail (20ce)052-737/fro yebe.rte-e9rn4;i,e00� <br /> Address 11-/0V-( (02,r4 A.le_. SE City/State/Zip Ey-ere-44, (,U A 982 08 <br /> APPLICANT: 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 /1 ( je,06, Inl State Lic.# AVA City Bus. Lic.# AO <br /> Address NIA Phone/Email /4/4 <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> To y E be--f-/e.- <br /> OA Phone/E-mail (2ofe)ISSZ=131(0/+7oye&ck..@c�rla;I.c..om. <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK/N/AJ <br /> Existing Use of Building S F' R. HEAT SOURCE: <br /> Proposed Use of Building C.ge Gas , Electric Other_ <br /> Building type: 2( Single Family _Duplex_Townhouse _Multi-Family _Commercial <br /> Type of project: New —Addition )6. Remodel .�Repair T.I. Sign_Sprinkler Demolition Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back):/ <br /> Repo:q-/Replace_ old pl.t.irnbial ? +"`)e -ture-Si {'�,�W t,-sv C.,�� \�� <br /> �P(�t0.C� 7'� r rto-cQ- r c- 3 `�ke ryvt c 4-z+ <br /> -? — �- - - = -_- .,. -' — . `� <br /> MECHANICAL PERMIT APPLICATION 'LUMBING PERMIT APPLICATION <br /> Type of Project: _New_Addn _Alteration pepair Type of Project: _New_Addn _Alteration,Repair <br /> Show Number(#)of fixtures Show Number(#)of fixtures <br /> A/C-air handling units 2 Toilet <br /> X Forced air systems 2 Bathtub <br /> le Gas piping 2Lavatory(wash basin) <br /> 1 Water heater Z Shower <br /> I Gas fireplace t Kitchen sink&disposal <br /> 1 Gas range k Dishwasher <br /> 1 Clothes dryer t Clothes washer <br /> 1 Range hood <br /> 3 or 4 Exhaust fan Sink(service/bar/mop/etc.) <br /> Cr Heat pump � Backflow preventer <br /> gf Unit heater 0 Urinal <br /> O Boiler Drinking Fountain <br /> O Refrigeration Floor drain <br /> fa' Woodstove 0 Grease trap <br /> IK Ducting 0 Roof drains <br /> I I Other aa-g nuc t4ro, / Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM 0 Other: <br /> Number of Heads f- 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 compl <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 <br /> 3/23/20/S <br /> caner/ ',zed Agent Signature Date (Revised 9/2014) <br />