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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: . PROPERTY TAX# PERMIT# <br /> 0-s z <br /> 4 r..).4 1.-7c s4 fkre_ 1,.��. tf 1--13n°1-00 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER Phone/E-mail <br /> Address City/State/Zip <br /> APPLICANT:_[Owner Owner's Agent <br /> j Contractor _Contractor's Agent _Tenant(must provide a letter of consent from the owner to do work in the space) <br /> CONTRACTOR C� ,,ter S Ac-sh:-.44,6,4�-.�,6-„1 State Lic.#pj¢() /2 5C.2 —ty Bus. Lic.# <br /> Address`?/'. [,i//it Si- S St,,A42.3-3 . 2 Ge 4.. 4 .„4. Phone/Email i5- - a/AC (x3 <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> �'r"'le-AG:.v►Xe4 (..-"n.-• .. Phone/E-mail 55G—L c. ,✓s're_)A 4!Z `e 44-77x'6 <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of Building G-4i`4-G- HEAT SOURCE: <br /> Proposed Use of Building (.;� '( +c' Gas Electric)( Other_ <br /> Building type: _Single Family Duplex Townhouse Multi-Family )C Commercial <br /> Type of project: New Addition _Remodel Repair_T.I. Signnn _Sprinkler_Demolition_Change of Use <br /> DESCRIPTION^OF WORK(additional space provided on the back): 1)/5,,..,c/( Kc9h.✓ c-1 ,/. pc� a,.Ae/71 C-rC - <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New_Addn _Alteration_Repair Type of Project: _New_Addn _Alterati n ),Repair Show Show Number(#)of fixtures Show Number(#)of fixtures � L-- r ,>s,,];x Vr <br /> A/C-air handling units Toilet `J <br /> Forced air systems ! Bathtub <br /> Gas piping Lavatory(wash basin) <br /> Water heater , j Shower <br /> Gas fireplace 2 Kitchen sink&disposal <br /> Gas range • Dishwasher <br /> Clothes dryer • Clothes washer <br /> Range hood s '\Water heater <br /> Exhaut.fan Sink(service/bar/mop/etc.) <br /> Heat pumpN, j Backflow preventer <br /> Unit heater \ Urinal\\ <br /> Boiler Drinking Rountain <br /> Refrigeration • <br /> Floor drain <br /> Woodstove Grease trap <br /> Ducting Roof drains <br /> Other I Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM Other: <br /> 110 1 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 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 I <br /> That I am authorized by the owner of this property to perform the work for which application is made and I comply with the State Contractors Law 1827 RCW and 296.200A WAS. <br /> 5'-20----/- <br /> Owner/Auth rized Agent Signature Date (Revised 3/2013) <br /> 1 <br />