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1113ERMIT 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 /> &"-�/t�ZFi7- l/4 �/��z nn/Dc'z'5/ 0 ILf( - 91 <br /> LEGAL for new construction: Shhoorrt'Pllat/subdivision Lot No.5V25-727_57, <br /> / (attach copy of long legal description) <br /> OWNER E ' /�(-� l/l�/ /i7/tJ� /4(/-77-7/e/7—)7� Phone/E-mail /ZST -�, �2 2 L <br /> Address ,F/4 7 (7G7_, T , City/State/Zip <br /> APPLICANT: /Owner _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 7444 S `fes (') /si.(. State Lic. #//A1(S//CC?9€ L,/ City Bus. Lic.#05:357/ <br /> Address n Phone/Email <br /> TENANT BUSINESS <br /> NAME CONTACT � .70 <br /> FOR PERMIT �� �/� <br /> // � <br /> �/f �-/' !/[/ Phone/E-mail 7/2 .56..77r} /�4j(/'//47:--V . d,� <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK ;.:,c e' v. 41-2) <br /> Existing Use of Building H,/AT SOURCE: <br /> Proposed Use of Building Gas VElectric 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 /> S/O/A1( <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 ; 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 <br /> Unit heater Urinal <br /> Boiler Drinking Fountain <br /> Refrigeration Floor drain • <br /> Woodstove Grease trap <br /> Ducting I 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-111..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 <br /> (Revised 3/2013) <br />