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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 /> 1 161 g--695 <br /> SITE ADDRESS. ERE IT# <br /> /©5 "/ 42 Z0a-u5 [PROP7X# qao <br /> LEGAL for new construction: Short Plat/subdivision Lot No..3 (attach copy of long legal description) <br /> OWNER /ItCQQ�- e/tj€ �'Of ,i,Sef Phone/E-mail �5 �� 636 / <br /> Address v 06t2)( /0 4,2 &Al-- City/State/Zip G 0464 2V/ e,(24_., <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 � /4-C State Lic.# Bu Lic. <br /> Address Phone/Email 01061 co n n, c Q'1e <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT " <br /> Phone/E-mail <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK 1 -P iU1 000,6) <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building ,EMST /t /G> GasX Electric_ Other <br /> Building type: _Single Family XDuplex_Townhouse _Multi-Family _Commercial <br /> Type of project: Y. <br /> New _Addition _Remodel _Repair_T.I._Sign_Sprinkler_Demolition_Change of Use <br /> DESCRIPTION OF WORK(additional splaste provided on the back): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project:XNew_Addn _Alteration_Repair Type of Project:,New_Addn _Alteration_Repair <br /> Show Number(#)of fixtures Show Number(#)of fixtures <br /> NC—air handling units <br /> Forced air systems . ' Bathtub <br /> /Q Ar Gas piping JO Lavatory(wash basin) <br /> `l Water heater <br /> 1,...% Shower <br /> Gas fireplacejr Kitchen sink&disposal <br /> f Gas range Dishwasher <br /> Clothes dryer Clothes washer <br /> Range hood 50. Water heater <br /> 6GIFExhaust fan 2 jT Sink(service/bar/mop/etc.) <br /> Heat pump Backflow preventer(inside bldg) <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 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 /> S/ 1—s' <br /> Owne Authorized Agent Signature ftfatte (Revised 4/2015) <br />