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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: PROPERTYTAX# ) rr/F�►RM+�;T�f��f <br /> CP, Alil {`1 5S(i� t f�'t. 1 �`�f rL- . 22)C:A ���i(Z YrS5oo ' ' I I Ab l —D7-4 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER „ 1 •` L frhone/Emall <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\ y �y�� State Lic.#M� j� n Ash t City Bus. Lic. <br /> Address ( �� t s�";('tf� 17VA's1 <br /> L rn�ry Phone/Email i -,p C4ki,.clort¢ - C M Lk 1.4 (-A k.c,.ti,. <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> ‘"\'1/21e"('is - Phone/E-mail <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK 2,tA Ci <br /> Existing Use of Building h LiC �\ t HEAT SOURCE: <br /> Proposed Use of Building 5 c. v-t_. GasElectric_\_ Other_ <br /> Building type: Single Family Duplex Townhouse _Multi-Family )(r Commercial <br /> Type of project: NA1 New _Addition Remodel Repair T.I. Sign Sprinkler Demolition Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): \,,` syr d,. ✓-1 S-..toak 12.71 ) . .)' c k <br /> \C 1) r•c & wur k e wr r ; s h ;1.-N 5 t�LL �" �u I;w, �,u !.cu.•-o—t <br /> \-.4r r• s h t - N'Ne.% <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 /> NC—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 /> 4 Exhaust fan Sink(service/bar/mop/etc.) <br /> Heat pump Backflow preventer(inside bldg) <br /> Unit heater Urinal <br /> Boiler Drinking Fountain <br /> 2. Refrigeration Floor drain <br /> Woodstove Grease trap <br /> Ducting Roof drains <br /> Other i�.i 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 authorized by the owner ofthisproperty 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/Authorize gent Signature Date (Revised 4/2015) <br /> IIz <br />