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9ERMIT APPLICATIA <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 i <br /> SITE ADDRESS: h PROPERTY TAX# PERMIT# <br /> v� 12)\4- U <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER �, Phone/E-mail — `AL4 <br /> Address t �- 00 City/State/Zip <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 �UfStateeL�icc..## A ��j Q Ly-City Bus. Lic.# 15\ <br /> Address a ba cC� �' �LDD101 Phone/Email & <br /> TENANT BUSINESS NAtM(`E� ( CONTACT FOR PERMIT <br /> Phone/E-mail <br /> BUILDING PERMIT kPPLICiILTION CONTRACT PRICE OF WORK 5-4-,OCO <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.I. Sin Sprinkler Demolition Chane of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): NCX `V1 \E OX CnA. <br /> V!I�rrlov\n -4�x*\'�A\n Corn ;gym 'i�;6\ `ts CL06 .�n'E3V OLM n `c*U-) <br /> 0"-1*016akkm * ar�d Cpccac�-� sh\ ��e S . No shy ° <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/mop/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 I am authorized 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 /> Owner/Authorized ent q ature Dae (Revised 4/2015) <br />