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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 /> CILAC11,7-coq <br /> SITE ADDRESS: VC(,­C-510C0C,5qC0 <br /> OPERTY TAX# PEAMIT# <br /> 2'72i LACD� �Jek�C <br /> LEGAL for new construction: Short PlaUsubdivision "� Lot No. (attaacch7coopy of long legal description) <br /> 0WNER LNr� � L WV)I ;` •) Phone/E-mail ,ltt. 1�/-'&620. �, <br /> Address 5'A*-J© DJ I LCOX• �L NCE 130`11"vc- City/State/Zip <br /> APPLICANT:—Owner _Owner's Agent Contractor <br /> ,—Contractor's Agent _Tenant(must provide a letter of consent from the owner to do work in the space) <br /> CONTRAC",TO"_Rf M,� ) 'A}l�(bl- '�60,LV/1 /�I tate/Li�c.# it'W '1►-tX 1 �ZLW City Bus. Lic.#CZ7­�6 <br /> Address 4�'uv�`C` 1 �1 G7�.)��r )-k 7Phone/Email +25•r6= �otil�'CY�1�"cZc .GIFt <br /> TENANT BUSINESS NAME CONTACT F3R PERM''I1�T'� <br /> t��tCi�•� <br /> Phone/E-mailt �j <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK UU <br /> Existing Use of Building t�' i)ckm`1q-// �/ y, HEAT SOURCE: <br /> Proposed Use of Building o�%kM-vWL—`/(VC��`FA7I1 l k) Gas--)( Electric_ Other_ <br /> Building type: '�, Single Family _Duplex_Townhouse _Multi-Family _Commercial <br /> Type of project: New Addition Remodel Repair_T.I._Sign_Sprinkler_DemolitionChange of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> ��M M I a b aAV-0 o m c o twe(f 2 b4-4,5 i K-h) I <br /> iN e 4 t a40ors <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 I Bathtub <br /> Gas piping Lavatory(wash basin) <br /> Water heater j Shower <br /> Gas fireplace Kitchen sink&disposal <br /> Gas range Dishwasher <br /> Clothes dryer I Clothes washer <br /> Range hood i Water heater <br /> Exhaust fan Sink(service/bar/mop/etc.) <br /> Heat pump I Backflow preventer <br /> Unit heater j Urinal <br /> j Boiler Drinking Fountain <br /> Refrigeration 2— j Floor drain <br /> Woodstove ; Grease trap <br /> Ducting Roof drains <br /> Other I Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM I 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 autho' ed 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 /> 710I;�Ov <br /> Owner/Authorized Agent Signature Date (Revised 3/2013) <br />