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0 0 <br /> 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# MIT# <br /> 60195 r l 2 (0—ca -a —oo I <br /> Pl 5, <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) r <br /> OWNER D&(.— Phone/E-mail Z�j% ul d fL L• O►� <br /> Address 3' � 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 ell State Lic.# City Bus. Lic.# <br /> Address Phone/Email <br /> TENANT BUSINESS NAME CONTACT FQR PERMIT <br /> I �-t IV^_`ctCG�J <br /> Phone/E-mail 4 d&[eiptiyea C <br /> *z, <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK I-5:CZ-O <br /> Existing Use of Building c dew.,C—- HEAT SOURCE: <br /> Proposed Use of Building Gas Electric_ Other <br /> Building type: Qs Ingle Family _Duplex_Townhouse _Multi-Family _Commercial <br /> Type of project: New Addition =&emodel _Repair_T.I._Sign_Sprinkler_Demolition_Change of Use <br /> DESCRIPTION OF WORK(additional space <br /> provided on the back): <br /> R&g0je.L ;/,-a1`6k-&4 c►.'-C 4.1n✓cLytl, o@mo '.2- G ose , cm I WJA It <br /> file- 0 er.& clts1 l'lvK l9 Kg -4ek4k,S 01�ec*4 c1 54i/4<e . <br /> MECHANICAL PERMIT AP/PLICATION 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 /> j Forced air systems j Bathtub <br /> j Gas piping j Lavatory(wash basin) <br /> j Water heater j Shower <br /> Gas fireplace j Kitchen sink&disposal <br /> j Gas range Dishwasher <br /> Clothes dryer Clothes washer <br /> Range hood / j Water heater <br /> Z j Exhaust fan j Sink(service/bar/mop/etc.) <br /> j Heat pump I Backflow preventer <br /> j Unit heater j Urinal <br /> Boiler Drinking Fountain <br /> j Refrigeration j Floor drain <br /> Woodstove j Grease trap <br /> Ducting j Roof drains <br /> Other Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM I Other: <br /> Number of Heads j 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 of thi erform the work for which application Is made and I comply with the Slate Contractors Law 18.27 RCW and 296.200A WAC. <br /> 5716 <br /> OwrkL4419b orized Agent Signature Dat (Revised 3/2013) <br />