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• 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: �r�Js U�2U PROPERTY TAX# PERMIT# <br /> a0/•7 - s 0 --0 D <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWN i S A,v 7AgK � 3 8� <br /> Phone/E-mail J <br /> 2 J) 4��0/IP.Il- City/State/Zip <br /> Address /•7 3vA- <br /> r <br /> APPLICANT: Own r _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 State Lic.# City Bus. Lic.# <br /> Address LSC t �" Phone/Email <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Phone/E-mail 4,Z-5-- 2-3 2' 7:�< %'-3 <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK -7 ( ; 00 a <br /> Existing Use of Building /;:�-P HEAT SOURCE: <br /> Proposed Use of Building '�r12— Gas_ 6 lectnc' Other__ <br /> Building typ ingle Fami _Duplex_Townhouse _Multi-Family _Commercial <br /> Type of project: New Addition Remodel` Repair_T.I._Sign_Sprinkler_Demolition_Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> v� (2-I o "f&-Yfl,os ,3e JG 0/71 <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New_Addn _Alteration_Repair Type of Project: _New.LC Addn _Alteration_Repair <br /> Show Number(#)of fixtures Show Number(#)of fixtures <br /> A/C-air handling units Toilet <br /> 1 Forced air systems Bathtub <br /> Gas piping ( i Lavatory(wash basin) <br /> Water heater Shower <br /> Gas fireplace ; Kitchen sink&disposal <br /> i Gas range j Dish%,rasher <br /> Clothes dryer Clothes washer <br /> Range hood Water heater <br /> ( ; Exhaust fan Sink(service/bar/mop/etc.) <br /> j Heat pump Backflow preventer <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 i 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 speciilod 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 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> zz_ZZ. / L. <br /> "11wneri tho ized Agent Sig,.at Date (Revised 3/2013) <br />