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• • <br /> PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOUTION <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: 8Z3G �i6� I <br /> jslO0 5-72d0/Ovvvv 'PERMIT fil2t t )7e <br /> LEGAL for new construction: Short Plat/subdivision <br /> Lot No. (attach copy of long legal description) <br /> OWNER ZL-VeZ 7-,4&,1///6' f&7-",/94/77 Phone/E-mail c72,j { 9z 7z <br /> Address �X 7 ` City/State/Zip ��. /Z/X ff.rl/ <br /> APPLICANT: /Owner Owners Agent Contractor Contractor's Agent _Tenant(must provide aletteer of consent from the ov,�er too do work in the space) <br /> CONTRACTOR I / 7 •�j/Virdei <br /> �--/i (St.ate Lic.# 6Oz 60 z9 VS <br /> City Bus.Lic.# <br /> 437ZZ <br /> Addressf2 O 6 " i ,i it <br /> (Phone/Email y(� 25-9 46 9. <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> geiA0lam/` GI/ aN <br /> Phone/E-mail 5/13. ? -7%) ,,,, /ve,-- ,v/4 0 - <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK /d OC)o. 60 <br /> Existing Use of Building 5-I.-=X2 <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 /> 4/6 <br /> AMA) ST,e c Tat. _7 t /4 c ' <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> • <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 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 Dishwasher <br /> Range hood Clothes washer <br /> Exhaust fan Water heater <br /> Heat pump Sink(service/bar/mop/etc.) <br /> Backflow preventer <br /> Unit heater I Urinal <br /> Boiler • Drinking Fountain <br /> Refrigeration <br /> Woodstove Floor drain <br /> Ducting Grease trap <br /> ter <br /> Roof drains _ _ <br /> O <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 will be comp! <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 ate. --.th.:ed 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 /> Owner/) zed Agent Signature - Date <br /> (Revised 9/2014) <br />