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S <br /> 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: PROPERTY TAX If PER IT# <br /> _Sfrc-e+ ��c• +- WA in( 3 l( - DO7✓ <br /> LEGAL for new construction: Shod Platt//subdivision is I Lot No. (attach copy of long legal description) <br /> OWNER �-- y iS +W.) jrSS r Imo/-') Phone/E-mail ,ZG'(v J - 1-1-`1 7 , <br /> Address 2 o C) L I iG c9 /Vt 51Y �-f FVC✓;..)<f-f W 4 City/State/Zip Et./ ✓-f; f W4 / �/ez 3 -� <br /> APPLICANT: v Owner Owner's Agent Contractor Contractors Agent Tenant(must provide a letter of consent from the owner to do work in the space) <br /> CONTRACTOR ()GU c- O( L . r.`) c' 4- State Lic. # City Bus. Lic. # <br /> Address Phone/Email <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Phone/E-mail CiW✓ILa 11'1{G <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK/� ^ <br /> Existing Use of Building G"?/\/.0 <br /> ' ,c4ccnfl e.t ?/�f91c. O�rG'�1 r �y HEAT SOURCE: <br /> / <br /> Proposed Use of Building \//o 1,19 e 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 /> Go• In c% -fro �rc-P/ocC, '/3 0/ Hu hou5c rod Q�" 2a rota/ of �4o S>r <br /> J yo F f" (/ / veto It 6e4, '- 1rke Ct,ph,> 4- ( 14 011 <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 systems Bathtub <br /> Gas piping j Lavatory(wash basin) <br /> Water heater j Shower <br /> Gas fireplace Kitchen sink &disposal <br /> Gas range j Dishwasher <br /> Clothes dryer j Clothes washer <br /> Range hood j 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 /> Number 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 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 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 /> ,I y / <br /> Ili <br /> Owner/Authorized Agent Signature Date (Revised 3/2013) <br />