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13 1'•10C\ -oo(�- 0 0 <br />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: 5Q O, � A <br />E��;� <br />PROPERTY TAX #PERA�'T <br />(f <br />409 — cl^ <br />LEGAL for new construction: Short Plat/subdivision <br />Lot No. (attach copy of long legal description) <br />OWNER Jt C ; �o,K� <br />10� <br />Phone/E-mail <br />Address <br />,1 <br />City/State/Zip .I�.Vt✓G ��� <br />APPLICANT: _ Owner Owner's Agent X Contractor <br />_ Contractor's Agent _ Tenant (must provide a letter of consent from the owner to do work in the space) <br />CONTRACTOR <br />�� <br />to Lic. # 0 Ni "/ MCaF-643VICity Bus. Lic. # Z <br />Address <br />Phone/Email <br />TENANT BUSINESS NAME <br />CONTACT FOR PERMIT <br />Zoe (.=.`i l- -(y 5 7 <br />Phone/E-mail C .(,;aj <br />BUILDING PERMIT APPLICATION <br />CONTRACT PRICE OF WORK <br />Existing Use of Building <br />HEAT SOURCE: <br />Proposed Use of Building <br />Gas Electric Other <br />Building type: _ Single Family _ Duplex _Townhouse _ Multi <br />-Family y. Commercial <br />Type of project: New Addition Remodel <br />Repair _ <br />T.I. _ Sign _Sprinkler _Demolition Change of Use <br />DESCRIPTION OF WORK (additional space provided on the back) : <br />o Kt <br />tc-,Qa-koo <br />y <br />MECHANICAL PERMIT APPLICATION <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteration _Repair <br />Type of Project: _New _Addn ,Alteration _Repair <br />Show Number (#) of fixtures <br />Show Number (#) of fixtures <br />A/C - air handling units <br />1 Toilet <br />Forced air systems <br />Bathtub <br />Gas piping <br />1 Lavatory (wash basin) <br />j Water heater <br />j Shower <br />Gas fireplace <br />Kitchen sink & disposal <br />Gas range <br />Dishwasher <br />Clothes dryer <br />Clothes washer <br />Range hood <br />Water heater <br />Exhaust fan <br />Sink (service/bar/mop/etc.) <br />Heat pump <br />Backflow preventer <br />Unit heater <br />Urinal <br />Boiler <br />i Drinking Fountain <br />Refrigeration <br />Floor drain <br />Woodstove <br />Grease trap <br />Ducting <br />Roof drains <br />Other <br />j Medical Gas <br />SPRINKLER / SUPPRESSION SYSTEM <br />j Other: <br />Number of Heads <br />I 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 />Owner/Authorized Agent Signat re Date (Revised 312013) <br />