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• • <br /> PERMIT APPLICATION <br /> B UILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLaTION <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# # �' <br /> id 7L,'4Jz2 i/ 5-r. JO ) ?ZOO/COOC)OI PEWIT l50/" <br /> 0 4W <br /> LEGAL for new construction: Short Plat/subdivision <br /> Lot No. (attach copy of long legal description) <br /> OWNER �a�,�F" /cam /kjr,QZ'7�/Phone/E-mail /2,5-,--'2,5----R 9zZL <br /> Address bOX /3-y7 / / <br /> City/State/Zip � "�• 7, f,492 06 <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. ahr—D • ('D/11S 7 State Lic.#‘02_06 Z5 y3 City Bus.Lic.#03 762 <br /> Address ,7/zie) lice.J1, AYe-- 61/ar (Phone/Email p75 275-9, 60j 7 <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Phone/E-mail/GS..J G. b-7 7 7 ,e,v/ &- y�AQ <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK /% 00 D, UO Pf7fJ <br /> Existing Use of Building 5�W <br /> HEAT SOURCE: <br /> Proposed Use of Building <br /> Gas Electric Other <br /> Building;type: _Single Family _Duplex Townhouse ✓Multi-Family _Commercial <br /> Type of project: New Addition V Remodel /Repair_T.I. Sign_Sprinkler_Demolition Change of Use <br /> DESCRIPTION� OF WORK(additional space provided on the back) <br /> f-��-� �,(_,l�S'F7-�' - Nf,IJ�%//�G/C%LI�-/G I`=/?�i'-1 ln.�G- <br /> • - u�c.J ,- ti15'�l4C.9 77.0A..) , . ' - <br /> 7)?GJA-LA -- <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION • <br /> • <br /> Type of Project: _New gddn Alteration Repair Type of Project: New Addn Alteration Repair <br /> Show Number(#)of fixtures Show Number(#)of fixtures <br /> A/C-air handling units I Toilet <br /> Forced air systems Bathtub <br /> Gas piping • <br /> Water heater Lavatory(wash basin) _ <br /> Gas fireplace Shower <br /> • Gas range Kitchen sink&disposal <br /> Clothes dryer I Dishwasher <br /> Range hood Clothes washer <br /> Exhaust fan Water heater <br /> Heat pump Sink(service/bar/mop/etc.) <br /> Unit heater <br /> Backflow preventer <br /> Boiler Urinal - <br /> Refrigeration <br /> Drinking Fountain <br /> Woodstove — Floor drain <br /> Ductin Grease trap <br /> g I Roof drains <br /> Other <br /> SPRINKLER/SUPPRESSION SYSTEM Medical Gas - <br /> 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 wit be comp) <br /> with whether specified herein or not.The granting of a pen-nit does not presume to give authority to violate or cancel the provision of any other state or local law regulating construction- <br /> That I a.—.th.�ed by the owner of this property to per-form the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> /'s-/, <br /> Owner/,f zed Agent Signature Date-- <br /> --- <br /> (Revised 9/2014) <br />