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SPERMIT 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# IT# <br /> ion LiL, �Q-�,.' ooyr 5Z Do/e) co v fc�1M 1c, <br /> 'c %,---/ <br /> LEGAL for new construction:� r7A <br /> Short Plat/subdivision Lot No. (attach copy <br /> of long legal description) <br /> OWNER Vt ,l ' ' AL7T�/I Phone/E-mail '772 57-2,3—‘57: 9Z Z. z— <br /> Address �DX /r5(7 City/State/Zip e—!z -, //J/t//9 972Z2/— <br /> APPLICANT:,X 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 /9Y.°G47,, State Lic.# / Ie{, . t°1 IU I Z. City Bus. Lic.# <br /> Address Phone/Email <br /> TENANT BUSINESS NAME CONTACT FOR PERMITgfir/14zY y /7 r-"Jt- <br /> ��' "�' �" �..„/ Phone/E-mail V2 293 5 6/,5 7----,e--7- <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK it o, 470 <br /> Existing Use of Building J—/c.e HEAT SOURCE: <br /> Proposed Use of Building 5F> Gas /r Electric Other <br /> Building type: _Single Family _Duplex Townhouse Multi-Family Commercial <br /> Type of project: New Addition A Remodel Repair T.I. Sign Sprinkler Demolition Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> rtpaz to <br /> 4 <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION v <br /> Type of Project: _New Addn/t 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(inside bldg) <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 mad 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 pacified 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 orized 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 /> Owner/Authorized Agent Signature Date (Revised 42015) <br />