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PERMIT APPLICATION <br /> BUILDING/MECHA!aICAL/PLUMBING/SIGN/SSNKLER/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# d0/ PERMIT.# <br /> .- = �- �� 1 005/ -97__ � O o�� � A, e, • <br /> LEGAL for new construction:Short Plat/subdivision Lot No. (attach copyoflong legal description) <br /> OWNER l/���// //U�f7/ //6,77,,,,,,,e�y Phone/E-mail �2 5 2. , z– <br /> Address fD Zdx � City/State/Zip& a-Yt !tr47 9(?27/ <br /> APPLICANT:,X Owner Owner's�lAgent _Contractor Contractor's Agent _Tenant(must provide a letter of consent from the owner to do work in the space) <br /> CONTRACTOR /��/�GC7/g State Lic.# /1�1,-Ir>65/)-C t�1 IO I Z City Bus. Lic.# <br /> Address Phone/Email <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT,a�� y /- ft.7Jc <br /> gi�C"7/",G`//- ``/-/ Phone/E-mail y2 x- 19,3 5-6/J T�xT <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK /60 O, 4r0 <br /> Existing Use of Building �/ HEAT SOURCE: <br /> Proposed Use of Building / /� Gas ElectricOther <br /> Building type: —Single Family Duplex_Townhouse _Multi-Family Commercial <br /> Type of project: New Addition X Remodel Repair_T.I. Sign Sprinkler Demolition Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> Vt , VI6-6 I/Uty--e - <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: New_Addn X 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 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 spired 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 authorized 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/Authorized Agent Signature Date (Revised 4/2015) <br />