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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: r'} / PROPERTY TAX# E it t irfq- <br /> O t ' <br /> LEGAL for new construction: Short Plat/subdivi T (4.1., Lot No. (attach copy of long legal description) <br /> OWNER P.(lC Cell fiVY _ Phone/E-mail (50'. ) 1103"f,22 <br /> Address("fie , v t Dr. `_Ott. I 1 y City/State/ZiKi 004 SoilN I l 1 FL, 32W2 <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 /> (lip-roelgTMTeR//�� /t lel G,.) (n t . !State Lic.# 1 ' 1 City Bus.Lic.# <br /> Address OM C �'� + .9,‘A. fid U�fl�lic/(�A �{? 3() Phone/Email ()Q I�) `''L� 5111 <br /> TENANT BUSINESS N ME CON ACT FOR PERMIT <br /> ` !' L() '5 Phone/E-mail I E_SIG,4t f 4 6V(0 .((/W <br /> BUIL 11 G PERMIT APPLICATION CONTRA P ICE Q�F WORKU it%al bO) <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building Gas Electric_ Other_ <br /> Building type: _Single Family 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 /> ¢l,cpIQC+•v exi&h'vt W�.vY;l s. h w-,�-l^ Cu V1 "�a..JOr'► d <br /> cX(JN-iUt-? Wvrt "�• Mil tato eki eIQ.L�i'*cd • ( + l <br /> J <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION j <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 systems Bathtub <br /> Gas piping Lavatory(wash basin) <br /> Water heater Shower <br /> Gas fireplace Kitchen sink&disposal <br /> Gas range Dishwasher <br /> Clothes dryer Clothes washer <br /> Range hood Water heater <br /> Exhaust fan Sink(service/bar/mop/etc.) <br /> Heat 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 /> SPRINKLER/SUPPRESSION SYSTEM Other: <br /> INumber 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 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• ner of this property to perform the workgfor which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> • <br /> .!/nu I l lj �l <br /> 0 uthorized Ag��ignat Date (Revised 9/2014) /: <br />