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Ik'ERMIT APPLICATIA <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 /> Jz 3 L_/Alz)rA/ S7. A— /� `J4 ,���< e9(2/ c'zl, I 0(14(D-D�J 7 <br /> LEGAL for new <br /> /construction: Short <br /> /Plat/subdivision Lot No.5'25-7(attach copyy of long legal description) <br /> OWNER & // <br /> f[/�/��� �/1 J /4(77/1— �� Phone/E-mail �,J , 2 2 <br /> Address 3/D 7 eat.pr /w- C City/State/Zip v�� f.//1 <br /> APPLICANT: VOwner _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 4i E S',/ (D/1.4I// State Lic.# R— /7 Ki-., 996D/ City Bus. Lic.# 7/ <br /> Address Phone/Email <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT r <br /> Phone/E-mailZS".)Da? 6.V6 /6"/(/A/r C-W;9• 4e6 <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK fl'S '' 49. ems) <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 /> /.0//16 <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 I Bathtub <br /> Gas piping Lavatory(wash basin) <br /> Water heater Shower <br /> Gas fireplace Kitchen sink&disposal <br /> Gas range Dishwasher <br /> Clothes dryer 1 Clothes washer <br /> Range hood Water heater <br /> Exhaust fan Sink(service/bar/mop/etc.) <br /> Heat pump I 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-uti.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 /> Owner/Au ' d Agent Signature Date (Revised 3/2013) <br />