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( �f <br /> PERMIT APPLICATION ,k)-s <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 /> 0.10LA4) flv-) !411 -oo 3 <br /> SITE ADDRESS: ]PROPERTY TAX# P MIT# <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER C1Z4 Phone/E-cfl' 0*-ri <br /> 14162CIAddress 1 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 0 A ynx State Lic.# City Bus. Lic. # <br /> Address OtA5 t,Y^4 QUkr i 2.4(( ( \ " S • Perekfi Phone/Email rt\A",5 Mut^ dk re 001• cdn^ <br /> TENANT BUSINESS NAMET C OR PER <br /> Phone/E-mail ) <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE O[=WORK r <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. Sign Sprinkler Demolition Change of Use <br /> DESCRIPTION OF WO K(additional space ed on the back): <br /> • tlar_ c29.111) 9eiiNP <br /> A J\C C <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 /> NC—air handling units Toilet <br /> Forced air systems Bathtub <br /> Gas piping Lavatory(wash basin) <br /> Water heater j Shower <br /> Gas fireplace Kitchen sink&disposal <br /> Gas range j Dishwasher <br /> Clothes dryer j Clothes washer <br /> Range hood Water heater <br /> Exhaust fan ! Sink(service/bar/mop/etc.) <br /> 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 I 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 complied <br /> with whether specified he or 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• ,'v -r 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 /> 11 <br /> Owner/Authorized Agent •ture Date (Revised 3/2013) <br />