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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# PE MIT# <br /> C�C7 3 �J C ''S I h CL '7 $ .� !5�0 1 op SC�b <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER 430Q,IYI Co, Phone/E-mail <br /> Address P.O. a0x 3?07 A $ 4 4 `13 City/State/Zip SCa We. , (,t/A Q F1 ZLt_ Z.7-67 <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 Mf((y1 Ti State Lic.# If QT FA((—16 li AC City Bus. Lic.# 0 <br /> Address Phone/Email <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT p01 V e?c�ler : Li7 -2.3q•�Tb <br /> Phone/E-mail dau I'd ., d--bb ),-r&} 60( .co <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building. Gas_ Electric_ Other_ <br /> Building type: T 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): UC t Y <br /> Ql � 5/L2 D- ce �10�rll�i' <br /> _ , l'0 �G2cJ <br /> ,Ghe lu��Ps Ye- C 1'WJ 4C- wet �6Id 3, <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 Toilet <br /> I Forced air systems Bathtub <br /> j Gas piping Lavatory(wash basin) <br /> I Water heater Shower <br /> j Gas fireplace Kitchen sink&disposal <br /> Gas range Dishwasher <br /> Clothes dryer j Clothes washer <br /> Range hood j Water heater <br /> Exhaust fan Sink(service/bar/mop/etc.) <br /> Heat pump Backflow preventer <br /> Unit heater <br /> Urinal <br /> Boiler j Drinking Fountain <br /> - Refrigeration----------.._. ----— — - --— ---_ <br /> _ j- _ 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 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 o his operty to perform the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC.7/ �Z ll!! <br /> / Z l a l� `L <br /> Owner/Authorized Agent S' nature ate <br /> (Revised 3/2013) <br />