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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 TAXI4 PERMIT#_, <br /> yJ <br /> 7I - Sri .€ -r O c53O000a30G i _U <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> • f <br /> OWNER +jiC1.i4.41.1S &WV I AMA Phone/E-mail 7 t) 1 �� .� �e- &.. <br /> Address l�/ 1� `� City/State/Zip ` UV <br /> APPLICANT weer 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- %ZIA050 J .JBT2Ch4 1 S-7 State Lic.# J kit).DC.°.C((16CC City Bus. Lic. # <br /> ddress-P.ll Wis. iqoqt �w f\ Phone/Email a ";�.5 111(0 I <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Phone:E-mail d <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK - �( 6Z,\. <br /> Existing Use of Building Jtr c � Qlu�IHEAT SOURCE: <br /> • <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): <br /> 41,Q_ ctr-Qa <br /> 42_�I d rc,c.K rertzLiA641 r <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: NewAddn _Alteration_Repair Type of Project: New Addn _Alteration Repair <br /> Show Number(#)of fixtures Show Number(#)of fixtures <br /> —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 j Floor drain <br /> Woodstove I 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 authori d by the owner of this properly 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 Signature Date (Revised 3/2013) <br />