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PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES 7-- $''--)5' <br /> 3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br /> SITE ADDRESS: . PROPERTY TAX# PE T# <br /> NAP-, �lt� '�.-..+- I005`(qq-PX)S-tom-- C) <� 15( — CO- <br /> , <br /> LEGAL for new constructs : Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> .OWNER a, g AL- ' mi 4 4Id 1' G Phone/E-mail. i -4'7a. 0.- u 4a yVal( Fia <br /> �I <br /> Address7�i a(� M �j� � City/State/Zip 'r00` (Ji 61 ( 4 ( ia <br /> . <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 /> CONTRACTOR A\ A State Lic.# City Bus. Lic.# <br /> Address Phone/Email <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT 'f�_Ivc?7. 14, <br /> Phone/E-mail "Z 6(p 3S 4-f 9 7 Z R <br /> BUILDING PERMIT APPLICATION CONT-1%4f PRICE OF WORK 4,-d16 d� <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building Gas_ Electric_ Other <br /> Building type: X 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 /> .4i. ) law ! ,U.ntiGd SI Clikaee" p7:ts.\'.A. 1(S�SL.�1 c"S) I JA,,'} ci' S, t-1-k-51 e.:iAC6C5) <br /> e. <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New_Addn _Alteration_Repair Type of Project: _New Addn _Alteration_Repair ;CM O( <br /> Show Number(#)of fixtures Show Number(#)of fixtures <br /> A/C-air handling units .7 — 3 Toilet <br /> I Forced air systems Bathtub <br /> ( <br /> Gas piping L- Lavatory(wash basin) <br /> Water heater . Shower <br /> Gas fireplace 1 ` I Kitchen sink&disposal <br /> Gas range L I Dishwasher <br /> I Clothes dryer I Clothes washer <br /> Range hood ` I Water heater <br /> g Exhaust fan Sink(service/bar/mop/etc.) <br /> Heat pump Backflow preventer(inside bldg) <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 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 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 uthorized 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 /> ,� A ��,� OS-l ti fS `� <br /> Owner/Aute rized Agent Sig ature Dae (Revised 4/2015) <br />