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• • <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# PERMIT#. <br /> l3 gy-j1, i 5� Z205 r� 7 o� o 'N LILL00 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER V i v ',2:Ct,1tlye 11 Phone/E-mail <br /> Address (�I s vv­ s4"- C City/State/Zip t—u vz-- f . INN <br /> APPLICANT:—Owner <br /> ,_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 t/V �i C�r State Lic. # City Bus. Lic.# <br /> Address Phone/Email <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Phone/E-mail r- \ �ui� l�2✓I'CU�� at 1•11J�/ <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK 2-525-00 <br /> Existing Use of Building II ,> r HEAT SOURCE: <br /> Proposed Use of Building �q� In�wt Ti rU �+ – Gas_ Electric_ Other <br /> Building type: ✓Single Family _Duplex_Townhouse _Multi-Family _Commercial <br /> Type of project: _New 1,`Xddition _Remodel Repair_T.I._Sign_Sprinkler_Demolition _Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <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 air systems j Bathtub <br /> j Gas piping Lavatory(wash basin) <br /> Water heater j', Shower <br /> Gas fireplace Kitchen sink&disposal <br /> Gas range hwasher <br /> ! Clothes dryer j Clothes washer <br /> ,Range hood ; WateY heater <br /> j Exhaust fan Sink(service/bar/mop/etc.) <br /> j HealTump I Backflow pi•eventer <br /> j Unit heets?r j Urinal <br /> j Boiler Drinking Fountain-, <br /> j Refrigeration j Floor drain <br /> Woodstove Grease trap <br /> Ducting I Roof drains <br /> Other Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM f 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 authorized by owner of this property to perforrp'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 Agent Si ature Dat (Revised 3/2013) <br />