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IIIII., 1 N <br /> � k <br /> PERMITAPPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> , CITY OF EVERETT,PERMIT SERVICES <br /> 3200 Cedar St, Everett, WA 98201 425;2•578,810,'',,FAX.425 257 8857' www everettwa org <br /> 4n:,;C6 <br /> SITE AD E S p�,,, •OPERTY TAX# P R IT <br /> ' OO1 W CASr1IO Ei:r c �6,. t � v- 0 <br /> LEGAL for new construction:. Short Plat/subdivision Lot No . : (attach copy of long legal description) , <br /> OWNER 9O I Pt 7 `2 _ Phone/E-mail <br /> Address Po`&.X-3101 ;MIS.1) ''.1-.5:1--- <br /> "J City/State/Zip, c Lf., WJ1 ' 4>1 2-2() <br /> APPLICANT _,Ownef Owners Agent _Contractor Contractor's Agent, • Tenant(must provide,a letter of conse'it from the owner to do work in the space) <br /> CONTRACTOR 5 k $ State Lic:-# 5J4ANS()Bc,$5 kr City Bus.•Lic.#•644.3.2!4) <br /> Address Phone/Email <br /> TENANT BUSINESS NAME CONTACT•,FOR PERMIT <br /> r <br /> . `� .DIZA`f F.�L�ia5 z3$ oc�1 <br /> Phone/E mall:2 u itif:'G•'i;sgA‘ie,l6 i.)6.lam k1; . <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE.OF•WORK' ' O, OOO <br /> Existing,Use of;Building •',' MFG,...'-: HEAT°SOURCEt <br /> Proposed Use'of Building MFG• Gas :` Electric_.:Other_ <br /> • Building type: T Single Family Duplex - Townhouse Multi Family , Commercial'`;` <br /> Type of project New _Addition_:'A Remodel. Repair ' T;1.. •_Sign_Sprinkler",Demolition Change of Use <br /> DESCRIPTION OF WORK(additional.'space.provided on the back): <br /> 4o-S Io Ca,,,AQS zT FSC- PR.�dcc - :54fr. €XTUtoL PIP) £ j t i/tc /9-A4• A <br /> ISO .=Pr Gt G 1p y ; <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of project:._New'_Addn __Alteration-_Repair:; Type of Project _Newr_Addn Alteration• . Repair <br /> Show Number(#)of fixtures _ Show Number(#)of fixtures <br /> A/C-air handling:units E Toilet <br /> Forced air:systems ; Bathtub <br /> I Gas piping :' <br /> I ;L'avatcry(wash basin) <br /> I Water heater j Shower- <br /> Gas fireplace' 1 ' - Kitchen sink&'disposal" <br /> Gas range • ; Dishwasher <br /> Clothes dryer ..>Clothes washer; <br /> Range hood ' 'Water heater <br /> Exhaust fan . 'Sink,(serviee/bar/mop/etc.)• <br /> Heat pump .1 Backflow preventer ' <br /> Unit heater Urinal <br /> Boiler ;i 'Drinking..Fountain <br /> Refrigeration . • FloOr drain <br /> Woodstove , Grease trap <br /> Ducting' I Roof drains <br /> Other) • <br /> 'Medical Gas <br /> .. SPRINKLER;/:.SUPPRESSION.SYSTEM- Other: <br /> I "Number of Heads , I •. 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 theprovision 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 /> . . 1411 <br /> ' ' -i /1-' .-'-- . <br /> ()wile✓ i ed Agent Sig tura,. Date (Revised 3/2013) <br />