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t • <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# _O <br /> --2-715-- /4Ew,7T F T Oce ,30 665-703:50- <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br /> OWNER Phone/E-mail dc k,;c e,4-,-r <br /> Address //-zr 3S •.26V6r4 0,-/Y,�: a������c- dam City/State/Zip /,�j,•��(� u,•`, �'bC 17 <br /> APPLICANT:_Owner _Owner's Agent Contractor _Contractor's Agent _Tenant(must provide a tetter of consent from the ownerto do work in the space) <br /> CONTRACTOR 0CC1 67,0 State Lic.# City Bus. Lic. # <br /> Address 7f%OS /cif>L� 2cS /Lz'��c"n�+sh, �L'fI :off yam' Phone/Email 4/Z> 70'3'127 c�(ti < C;-(�c Grd. <br /> (b�r7 <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Phone/E-mail < r/Z;�7>� "��`7:17 C <br /> 13UILIING PERMIT°APPLICATION CONTRACT PRICE OF WORK# Gam- I j2j� n(2 <br /> Existing Use of Building SEI q _ HEAT SOURCE: <br /> Proposed Use of Building s%Hl// �@�f=/fit Gast" Electric_ Other_ <br /> Building type: _Single Family _Duplex_Townhouse _Multi-Family _Commercial <br /> Type of project: New _Addition Remodel Repair I/T.I._Sign_Sprinkler_Demolition _Change of Use <br /> DESCRIPTION OF WOK(additional space provided on the back) <br /> D t-r6 60IF"n->£/ZCif�L i�Ldir7 Tp Crc�-rc lv�f�! Sctj- o�FlG�. F3� <br /> //,3O �4� 2E<��9 vrsarv� .fr�.a —,,c- y l'c=r /4*9" . <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type o roiect: _New_Addn _Alteration_Repair Type of Pr " ct: _New_Addn _Alteration_Repair <br /> Show Number(#)of fixtures how Number(#)of fixtures <br /> A/C-air handling units 1 Toilet <br /> Forced air systems Bathtub <br /> Gas piping 3 Lavatory(wash basin) <br /> Water heater NShower <br /> Gas fireplace chen sink&disposal <br /> Gas range DisNyasher <br /> ! Clothes dryer ClothN washer <br /> nge hood f i Water h ter <br /> Ex ust fan 3 1 Sink(serve /bar/mop/etc.) <br /> Heat p t Backflow pr6pnter <br /> Unit heatier, Urinal <br /> ! Boiler ! Drinking Fountain <br /> Refrigeration j Floor drain <br /> � Woodstove I Grease trap <br /> Ducting Roof drains <br /> Other Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM I Other:. - N <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 the owner of this property to perform the work for which application is made and I comply with the Slate Contractors Law 18.27 RCW and 296.200A WAC. <br /> tL <br /> Owner/Authorized Agent Signature Dae (Revised 3/2013) <br />