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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 St PE MIT <br /> cc bE'UGRLY t3LUO. 0o&3WOCCC1000 �[ U70000 <br /> LEGAL for new construction: Short Plat/subdivisionpp /t Lot No. <br /> (attach copy of long legal description) <br /> • <br /> OWNER Ramer. � iHe�� 1]Cs,je_ll Phone/E-mail z -3S6-O3 fy / 0111` 5„+r=lietv.nre,'t .he-i <br /> 6, <br /> Address 60-4 1le1J <br /> Vpr4y 0)0, City/State/Zip Lie <br /> re. <br /> f i VJ4 9 z,o3 <br /> APPLICANT: X 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 Co ne( State Lic.# City Bus. Lic.# <br /> Address Phone/Email <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Phone/E-mail Darren q2S. 3S c-03 11 <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK 30/ <br /> Existing Use of Building,5/14tile /Ot/V1r/y gee ideince HEAT SOURCE: <br /> Proposed Use of Building 6 Int it. /[.tovy fr I' itlPnCR Gas,X Electric_ Other <br /> Building type: ✓Single Family _Duplex_Townhouse _Multi-Family _Commercial <br /> Type of project: _New X Addition _Remodel Repair_T.I. Sign_Sprinkler Demolition Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> DOiTioN of 'VI sf TO E,5tsTIN6 t-touSC <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New XAddn _Alteration_Repair Type of Project: _New X.Addn _Alteration_Repair <br /> Show Number(#)of fixtures Show Number(#)of fixtures <br /> A/C-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 /> f Clothes dryer ( Clothes washer <br /> Range hood I Water heater <br /> Exhaust fan Sink(service/bar/mop/etc.) <br /> Heat pump Backflow preventer <br /> Unit heater Urinal <br /> Boiler f Drinking Fountain <br /> Refrigeration Floor drain • <br /> Woodstove Grease trap <br /> Ducting Roof drains <br /> / <br /> Other DuMess flecri�rltfn Syshee. Medical Gas <br /> SPRINKLER/ SUPPRESSION SYST'EM 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 authorized by the owner of this property to pert rm the work for which application Is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> ovnypt.t.A.N.„ 1/ 4 ON I/ <br /> er/Authorized Agent Signature Date (Revised 3/2013) <br />