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PERMIT APPLICATI N <br /> BUILDING/MECAICAL/PLUMBING/SIGN/S NKLER/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# P RMITL <br /> 005/4 - 92, d 0/Z2O O ) I \ >C`7' 0(94 <br /> LEGAL for new construction:�Shhort Plat/subdivision Lot No. (attach copyoflong legal description) <br /> �G���// <br /> OWNER 7lNC7 �CJTyD <br /> �' Phone/E-mail / �5 CJ �4iL7 � <br /> / i <br /> Address fD ZD/ /S-3( <br /> 7 City/State/Zip 677/(271 1 %1 9617.22/1- <br /> APPLICANT:,' Owner Owner's Agent _Contractor Contractors Agent _P Tenant(must provide a letter of consent from the owner to do work in the space) <br /> / <br /> CONTRACTOR /40G/7/( State Lic.# 1����( �� °i IU I Z.. City Bus. Lic.# <br /> Address Phone/Email <br /> TENANT fB�U/SIINN�ESS NAME CONTACT FOR PERMIT4,l�� y // 7 71/x` <br /> • <br /> v�C�'7/",/ // 24J Phone/E-mail 293 56 a 7-6;e7- <br /> BUILDING <br /> 6;eTBUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK /60 0. 4M <br /> Existing Use of Building J/ HEAT SOURCE: <br /> Proposed Use of Building F/� Gas_X Electric Other <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 /> r q II,CC. /t,Y <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: New_Addn X Alteration_Repair Type of Project: NewAddn 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 compl <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 stale or local law regulating construction <br /> That I am authorfz d by th 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 298.200A WAC. <br /> • <br /> //(// (/ <br /> Owner/Authorized gent Signature Date (Revised 4/1015) <br />