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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.arg <br /> LSk" ajr -2gosigooro3zDi) <br /> SITE ADDRESS: PROPERTY TAX# PERMIT# <br /> I t7(o 7 ZB'DS`/9�/p?�Dt7 c 1 061 -01 -3 <br /> P��..�vJ of GY: <br /> LEGAL for new�� construction:tShort Plat/su6dlvislon Lot No. (attach copy of long legal description) <br /> OWNER 1 3Rht.L COt.S ' U-G Phone/E-mail LC=he l wINa to & 1>Vt CI die k*ter.WM <br /> Address 17'Z1 to-lu -Ewar rtrlvV. SLtTtg 11�City/State/Zip gu1 Eu.. r W,4. QBd(2- <br /> APPLICANT: <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 SQM^'t RS 0.bOV State Lic.# City Bus. Lic.# <br /> Address same. las above. Phone/Email g WA. ar ct i ou°. <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Phone/E-mail g•abA-a.t ttb 0 <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK t I S Z.1 S 1 D <br /> Existing Use of R,at.r..- , WA HEAT SOURCE: <br /> Proposed Use ur building A-Tr n JCINASGas ✓ Electric_ Other <br /> Building type: ✓Single Family Duplex ✓Townhouse ✓Multi-Family _Commercial <br /> --Type of project: NeNew _Addition Remodel _Repair_T.I. Sign Sprinkler_Demolition Change of Use <br /> iESCRIPTION OF WORK(additional space provided on the back): <br /> 14 >v .1401a6 vkrtr A-5 <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 3 Toilet <br /> I Forced air systems Z Bathtub <br /> y Gas piping 3 Lavatory(wash basin) <br /> 1 Water heater Shower <br /> Gas fireplace I Kitchen sink&disposal <br /> Gas range t Dishwasher <br /> II Clothes dryer1 Clothes washer <br /> I Range hood 1 "'"'"'• <br /> 4. Exhaust fan • Sink(service/bar/mop/etc.) <br /> Heat pump I 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 /> Number of Heads Other: <br /> ..,,ereby 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 vyill 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 constry ction <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 296.20Af.. <br /> '� 1�2 <br /> / r <br /> Owner/Aut . _ •gent Signature Date (Revised 3/2013) <br />