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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 /> IgIq <br /> SITE ADDRESS: , r(elk\&fid 4 /p PRO©oS63Z3�1`8Qo4 bC P01- 1 \ 1-� 601, <br /> LEGAL for new construction: Short, Plat/subdivision C Lot No. (attach copy of long legal description) <br /> OWNER 004-44/a I0/et Sic/«&y Phone/E-mail /LS 7-34 6(�40/n haWie/G,ie,(CZe/@"a//.cNt <br /> Address No- 1-11,1h(t7VLGl /`t Y e City/State/Zip _UVK ffr WA 982o/ <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 Ow jUg12--- State Lic.# City Bus.Lic.# <br /> Address Phone/Email <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> 4.1/4.71 c' a.lekt- 44V .+3 <br /> Phone/E-mail \o cdaSttcy 'L�G w1GL-I.t .C W <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of Building 2eQ�dei (Id HEAT SOURCE: <br /> Proposed Use of Building gec) eri 1 C j Gas y Electric Other <br /> Building type: Sins - amily Duplex_Townhouse _Multi-Family _Commercial <br /> Type of project: i A•ddition _Remodel _Repair T.I. Sign_Sprinkler_Demolition_Change of Use <br /> DESCRIPTION 0 a <br /> ; - (additional space provided on the back): <br /> Add 6/o 5. DAD <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 /> 0.4 i 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 comp <br /> with whether specified herein or n.- he 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., the w 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 /> ` 41.40ip.._ �► <br /> Owner/Authorized Agent-'�ture Date (Revised 9/2014) <br /> Lp <br />