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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 /> 3 3 26' ,aCA �//y S6 ( fl--� Z' "? t 0,�? <br /> ` of <br /> LEGAL for new con truction: ort4 lat su division Lot No. (attach copy of long legal description) <br /> OWNER Ch ✓/ pt.'1� 77;:te.t / e67-t e•r/ Phone/E-mail 64=7-5)s) .3o3 �-g 5.27 <br /> .57..57.3/ r A <br /> Address � � k ";v7`�Td� 41"? ✓v-� <br /> €• City/State/Zip C ' lj h' 1 1'8.2623 <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 r ',.>r'C State Lic. # City Bus. Lic. # <br /> Address Phone/Email <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Phone/E-mail <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK r() <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building 5 I2&5L- Gas Electric / Other___ <br /> Building type: X Single Family Duplex Townhouse Multi-Family Commercial <br /> Type of project. New Addition Remodel 1( <br /> Repair_T.I. Sign Sprinkler_Demolition Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> Aca I wc..w For IG.c-fir-L o-- Ct.lotitt, last 4119914:14"c <br /> (GcXrc--� gA-t't,rovw` �/a,v�l /'Tp}tom .sr e <br /> VYS'JAJr- �. �plvw.�j�H� toSoes ' ••, <br /> ''�11 MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New_Adds Alteration Repair Type of Project: New Addn _Alteration Repair <br /> Show Number(#)of fixtures Show Number(#)of fixtures <br /> A/C air handling units fl Toilet <br /> Forced air systems j 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 /> 4 Range hood j 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 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 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 /> /.7/.f‘ <br /> Owner/Authorized Agent Signature Date (Revised 3/2013) <br />