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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 /> 1�10t l.dw,bkrJ qv& £Yeret�,w� gg�o( 00450(02.ssooIoo ( �; —U(V, <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br /> OWNER TAtiIE �L ovGa�-►�cgS Phone/E-mail I.Co'M <br /> Address Sftw-w Sit• City/State/Zip <br /> APPLICANT:_)�,Owner _Owner's Agent _Contractor Contractor's Agent _Tenant(must provide a letter of consent from the owner to do v.ork in the space) <br /> CONTRACTOR QWMtr State Lic.# City Bus. Lic.# <br /> Address Phone/Email <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Phone/E-mail 0 W hQ r <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK t30,000 <br /> Existing Use of Building_ SFR HEAT SOURCE: <br /> Proposed Use of Building SFR Gas Electric Other <br /> Building type: )4, Single Family _Duplex_Townhouse _Multi-Family _Commercial <br /> Type ofproject: New Addition Remodel Repair T.I. Sin Sprinkler Demolition _Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> i�1dA p•. +w..w.A14.,dlonwtys 11+rv,+ Xvwc wallg�o�r,.d, o` 6a-tl roo,n.., A0 '1� +lxis�iwJ a 2"`I Jlwr <br /> g�aca-. Sp"u.io ba. oolA WIda ;L"k4A)&U," kc,+ pv+Ke. Two -f--delt SkONtk,�s wlQ <br /> \&L ad&0, kJA4u� oittvn r&gjtvs. %4,L E <br /> is b ' <br /> no- JA&,A,A- � `NW% pn� C .g un'll lot In>54'E ",-0,0* aaxr3.I�W 4-L wo..rel 40r rewrds. <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: x New_Addn _Alteration_Repair Type of Project: X_NewAddn _Alteration_Repair <br /> Show Number(#)of fixtures Show Number(#)of fixtures <br /> A/C—air handling units X Toilet <br /> Forced airs stems Bathtub <br /> Gas piping X 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 inside bld <br /> Unit heater Urinal <br /> Boiler Drinking Fountain <br /> Refrigeration Floor drain <br /> Woodstove Grease trap <br /> X 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 lays and ordinances governing this type of work will be comp <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_thaoe ner=thrtyeAorm 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 1 ture Date (Revised 412015) <br />