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III • <br /> PERMIT APPLICATION <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: c, PROPERTY TAX# PERMIT# <br /> LC = s CJ . 005%92 oo/v000° 111 I-1(DC1.2-0 -;---- <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER !/G` /7 1./2//11 f1'7//,,e/7 / Phone/E-mail Y,2-57-25—‘7.c g7 7 7- <br /> Address fD,,n/e' try 7 City/State/Zip 6-7,t----,.. ; rr 9j77.O/ <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 /9N41.. G/9/(7 State Lic.#4NilC)'}( 1`117)I Z City Bus. Lic.#62-401;C) <br /> Address Phone/Email <br /> TENANT BUSINESSS NAME CONTACT FOR PERMIT ,IJ 9 y #67 r/144— <br /> g ////)v / ' `/ Phone/E-mail V2„3---7_93 r6/j 7--;e7- <br /> BUILDING <br /> 7BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK ,/6o 7, en <br /> Existing Use of Building 5-/C- � HEAT SOURCE: <br /> Proposed Use of Building 5�,K 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 /> egia.c-e ,ratio <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 spe 'fled 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 auth d by the own r of this property to perform the work for hich a plication is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC.c <br /> Owner/Authorized Agent Signature Date (Revised 4/2015) <br />