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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 /> 00 3 C a s i z.$�)L41-6Y)o r oo Sv6 G� <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER (.�OC'.1tr1 CQ, Phone/E-mail <br /> Address P.O. a0K 3'70.7 A $ 01+ --13 City/StateOp Seale. If WA If F1 ZLt_ ZZ-07 <br /> APPLICANT:-K —Owner's Agent _Contractor —Contractors Agent _Tenant(must provide a letter of consent from the owner to do work In the space) <br /> CONTRACTOR I'RC(r1 State Lic.# If OT CL 16 4 A1C, City Bus. Lic.# b <br /> Address Phone/Email <br /> TENANT BUSINESS NAME CONTACT FOR PERMITpj Q,L�e7yler �(ZS-Z.3Q'�'q <br /> Phone/E-mail dau ted `a• VIJi ° ''�} f'QQ� ,COlYL <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: _Single Family _Duplex_Townhouse _Multi-Family _Commercial <br /> Type of project: _New _Addition —Remodel _Repair_T.1._Sign_Sprinkler_Demo Iition_Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> 031� - lv)< ifol �room <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 /> 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 /> Exhaust fan Sink(service/bar/mop/etc.) <br /> Heat pump { Backflow preventer <br /> Unit heater { Urinal <br /> Boiler { Drinking Fountain <br /> --.. Refrigeration -7 ____._ <br /> _ - __.--___ - -- ------- -_ ,-_Floor drain- -- -- <br /> W sting ve 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 oF <br /> erty 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 /> z-/1 1/(4 ` <br /> OwtierlAu orizedAgen Signature Date (Revised 212013) <br />