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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: -2 Z a DORQ "ePROPERTY TAX# PE M'I r; 02L <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br /> �j <br /> OWNER r'cV-JA-"1> -P57411F V—iArV. Phone/E-mail <br /> Address 7-06 1-14" VL WC ti p City/State/Zip RI--I t-eVLt� � 806 <br /> APPLICANT: Owner Owner's Agent *?4 Contractor Contractor's Agent Tenant(must provide a letter of consent from the owner to do work in the space) <br /> CONTRACTOR 17�JtJk��.E 'Rc6r-=bJ(v State Lic.#1 ,.lNAR{ gl'IP City Bus. Lic # C)S 1°jy9 <br /> Address SOI t4 2 O'2*" sT S tAi Phone/Email ZO` (040'81a <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Zplo Oita( 6(v $$ --(r <br /> Phone/E-mail �,y�►q j/�h ir1C�r OCJt�� r <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK lot tois, o0 <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building Gas Electric Other <br /> Building type: Single Family X Duplex_Townhouse Multi-Family Commercial <br /> Type of project: New Addition Remodel Re air T.1. Sin Sprinkler Demolition Chane of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> T2��•a�/E 'Ex 1 s�h�.,.� �S Pti�1+ 51�;..��e.g , � p I�c E 17�w..4q.�. <br /> X46,14- it etard~c <br /> W wt�N��tre S S �ci �cwd-�'ah g <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 airs stems 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/mo /etc. <br /> Heat pump Backflow preventer inside bldg) <br /> Unit heater Urinal <br /> Boiler Drinking Fountain <br /> Refrigeration 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 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�auth edby the owner of thZprertyto perf/7-- <br /> Owner/AuAlitend <br /> rm the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> . �Agent Signature Date (Revised 4/2015) <br />