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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# PERM T# <br /> ekKes — I l <br /> LEGAL for new construction:_Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER R J n I l J� C Le" C( Phone/E-mail 5-,20 6 - "1‘3 /S-9 7 <br /> Address 2 7 3 0 D .kP S A�-�_ City/State/Zip <br /> APPLICANT:_Owner X 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/ Ai S r ✓✓l./ State Lic.# /)/b✓w'll/1/ -Yc/a9P't City Bus.Lic.# � l 1)(1-fir. (/2 3J(S <br /> Address 023`!L V-,/( w.1/t I\0J9 Phone/EmailS <br /> y ar' 1yy -6`1/r �'r"'� <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT / p <br /> Phone/E-mail f j 4.- St s)h S. U/L‘ <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK 471,I12— <br /> Existing Use of Building C ►w r-C HEAT SOURCE: <br /> Proposed Use of Building a v r'C Gas_ Electric_ Other <br /> Building type: _Single Family _Duplex_Townhouse Multi-Family x Commercial <br /> Type of project: _New _Addition _Remodel _Repair_T.I.16_Sign_Sprinkler Demolition Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> ti✓it (( N'tlSH✓t+e� �i;c :.s - vl 1 "', .� — A_ U+ t' 1NOr)-Lit, <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 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 I Drinking Fountain <br /> Refrigeration Floor drain <br /> Woodstove Grease trap <br /> I 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 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 authorized 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 /> / y/aD, <br /> Owner/Authorized Agent Signature Date (Revised 9/2014) <br />