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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 /> 2_601 V ( 1R1l 4 Otl_ X 11-11 0-050 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER ‘100,E_ I Phone/E-mail / <br /> Address 2_60 v((z6/rvr'A Ake City/State/Zip Vee_/f WA- <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 /> ��r) <br /> CONTRACTOR f—gj3V11CP,E� t(C �F-wvState Lic.# /V 187 boil City Bus. Lic.# <br /> Address `(lc( 16 Cf fv(SfScA) 2.'7/ (17,6`'t...-f474.4- Phone/Email a:�''.39(--C-76-7 O .2-CC/ <br /> TENANT BUSINESS NAME CONTACT FOR H'/PERMIT /�/ <br /> Phone/E-mail j�/e4f/eL- 20C--3W-676-7 <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK /U 000 <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building Gas Electric Other <br /> Building type: _Single Family _Duplex_Townhouse _Multi-Family _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): S , �f <br /> P— J(AJ, O POOP NEW P0019°LID/ ,(/mu/ coir <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 Other: <br /> Number • 'eads ( Other: <br /> I hereby certify that I have read and exa 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 spec' ed h in or not.Th • anting 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 author d by = • ner•f t -property to perform the work for which applica' n is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> /0 <br /> Owner/A horized Agent Signature Dat (Revised 3/2013) <br />