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'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# PE MIT <br /> 7�D �o<</ST 5r. %f/�l �s Q� ��/ 2 O opo fr � I ikf <br /> LEGAL for new construction: ShortJPllaUsubdi/vision Lot No. (attach copy of long legal description) <br /> OWNER � � S//I777 7Phone/E-mail 5r25-7275—F. <br /> r25-7G5— ;i.17 2 Z.- <br /> Address <br /> Address 3/ 7 (lQ /,,ffs/ <br /> City/State/Zip �/����� .//1 <br /> APPLICANT: IVOwner _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 X4 // (C'/VX -. State Lic.#/4W1,1y'(C f'9QO/ City Bus. Lic. #A-3 f/ <br /> Address Phone/Email <br /> TENAT BUSINESS NAME CONTACT FOR(� PERMIT �� <br /> 617/1//1_0074.1 Phone/E-mail V2575 63/6 N r . 4e6 <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK S>C), Z) <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 /> 5/.0/N G <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 /> NC—air handling units Toilet <br /> Forced air systems Bathtub <br /> Gas piping ) Lavatory (wash basin) <br /> Water heater I 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 I 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 wit 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-ut •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 <br /> d Agent Signature Date (Revised 3/2013) <br />