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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 Ft PERMIT#2, -�! ts ,G, <br /> 7 � / l 6 /{' D, �v Et'' Pre lyA fh' A J 1 iv L 'v J,1 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER Dar, r d ()/' tinri44 Phone/E-mail (?),c)21-5 %nd� diy!% Vc%��fn>'. i(.. <br /> Address ,7 7?'f /1i7'4 1),.. iV, City/State/Zip V'ft/I/ l,Z%/f ‘7,3",}c• <br /> APPLICANT: ,X, Owner Owner's Agent Contractor Contractors Agent Tenant(must provide a letter or consent from the owner to do work in the space) <br /> CONTRACTOR State Lic. # City Bus. Lic. # <br /> Address Phone/Email <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Phone/E-mail <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of Building Hivi+1t' HEAT SOURCE: <br /> Proposed Use of Building.��1A, I r i of he/ /v Gas x Electric Other <br /> Building type: gje Family uplex Townhouse Multi-Family _Commercial <br /> Type of projectew Addition Remodel Repair T.I. Sign Sprinkler Demolition Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> W;•,nc9 ;e) r hot h-,ib a -i3 eidcti/7<l a ,I;Uv O4/71/e7 ,,1 f6✓ 4/61e. <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 j Toilet <br /> Forced air systems Bathtub <br /> Gas piping j 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 of Heads <br /> 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 theowne 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/Aut orized Agent Signature Date (Revised 3/2013) <br />