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• 0 <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: PROPERJY TAX# A PERMIT# <br /> 1y/ %'i)( L/1% 57 E—W"i r` 7./4 s"- t) .1/'D,:J P) (q (0 - '7 <br /> LEGAL for new construction: ShortlPllat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER �JV /27[ /�(/�/��/t�� �(/7 ,€/� Phone/E-mail y/''s �Z 2 Z <br /> Address ,F/U 7 (QC.fI t7(�� C City/State/Zip v�� 7 74//1, / <br /> APPLICANT: V 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 /> [i L/457/CONTRACTOR (2)/l / <br /> lcI T , State Lic.#7if//7/$f(eIgo /r City Bus. Lic.#(5.5-3.57/ <br /> Address Phone/Email <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT -/F-c;),/t/ <br /> NA~V/ Phone/E-mail VZ.57525&? <br /> . 6 <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK el c)cam . <br /> ._, ;) cr-Z) <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building // Gas✓ Electric Other <br /> Building type: Single Family _Duplex_Townhouse VMulti-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,L'//1/t <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 I Shower <br /> Gas fireplace I Kitchen sink&disposal <br /> Gas range I 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 I Urinal <br /> Boiler I Drinking Fountain <br /> 1 Refrigeration Floor drain <br /> Woodstove I 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 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 /> : Vcz <br /> Owner/Au ' d Agent Signature Date (Revised 3/2013) <br />