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�ERMIT APPLICATIAI <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# PERMIT# <br /> `' <br /> D / r' 0 ' �Ot? J ! <br /> LEGAL for new construction:trShort <br /> Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER Gi-/ �/L st�(-Q/�� z,U yQ(/IS//r�� A/7"7-/.. /// )7 Phone/E-mail 3"25-72.�,5, 2 Z <br /> Address 3/D 7 p7"/ ,4V City/State/Zip 7/ 7 f//1 <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 /, 1 S7/ ��tis7 State Lic. #/m(s/7(C We) / City Bus. Lic.AOC3SW <br /> Address Phone/Email <br /> TENANT BUSINESS/ I /NAAM/EE CONTACT FOR�/ PERMITR2A/ ,er - '/ <br /> 6'',C(/ / V ! 'C V Phone/E-mail 7�.���� 6✓�?C/ /S6j(//)/l1 C(//V4• ,e)/e6. <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK •)n , c <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 /> s/a//tom <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 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 /> 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-utr•rized 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 /> / \ <br /> Owner/Au t d Agent Signature Date (Revised 3/2013) <br />