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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 t# PERMIT <br /> 300c) (Z�ct�F_F�= -crG—[ - V P�I OS'0 ba, <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER S?\)0 4Or+-t I.S f.} C o./T/ Phone/E-mail <br /> Address3ooD (a_oc �F-L�C.+ (2._ , 1cc City/State/Zip l iX- ( j, <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 (9 (A? State Lie.# City Bus. Lie.# <br /> Address Phone/Email <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Cc)LjQ-Tt4CuSw- Phone/E-mail 07.4‘1:14-)10, Si41fTl4 57Ve, CO . <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building Gas_ Electric Other <br /> Building type: Single Family _Duplex Townhouse _Multi-Family X 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 /> ?Cn i El> C5c-t-004/.3c V S t GALS :0i4-T5 A, t3/ C - <br /> atm, y cone-,- „"-tS 0i) 1ST ( Oocz . 004 l60 735— <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 Roof drains <br /> Other ( Medical Gas <br /> SPRINKLER/SUPPRESSION SYSTEM I Other: <br /> Number of Heads f 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 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. 1.4/ <br /> Z <br /> C - <br /> 0 4'/Authorized Agent Signature Date (Revised 3/2013) <br />