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0 10 <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: PROPERTYTAX# P.�RMIT#, . <br /> A-trc_ f <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER Phone/E-mail �4 -7 -3-7 G U 7L.) <br /> Address I I.fi, City/State/Zip tom', r / Cjk"Zt; <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 ; 4 c?C,, ��I c ,wi r _ _ State Lic.#MOC! ��� IYS .j J (; City Bus. Lic. #QS L S <br /> L/, 5 7L v 5•3bO <br /> Address ) 75 j 7 -tj 5C- '76.iU �, Lv/ I �j 2C-i'Ci Phone/Email �. <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Phone/E-mail <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <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 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 Bathtub <br /> Gas piping Lavatory (wash basin) <br /> Water heater ! Shower <br /> Gas fireplace ! Kitchen sink&disposal <br /> Gas range Dishwasher <br /> j 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 j Drinking Fountain <br /> Refrigeration ! Floor drain <br /> Woodstove Grease trap <br /> I Ducting I Roof drains <br /> Other 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 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 State Contractors Law 18.27 RCW and 296.200A WAC. <br /> ::� -/ 11--A— 2 - )-`(-/ S' <br /> Own r/Authorized Agent Signature Date (Revised 3/2013) <br />