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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# P RMT# <br /> 32/'/ Q/Zeit:LIAM,V . 1 y L D op <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER A/D,Crtf / w jT 5 ,t4 Pitieriteret,5 Phone/E-mail <br /> Address //6 — //Q Avg iti4E 5119 City/State/Zip (A-2.z,I tic/E. <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 r9C1�1� State Lic.#GR>1=�,� �gC.;City Bus. Lic.# p2C€ <br /> Address L� C/v` 1J Phone/Email <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> bi4-ve 50..,wj ' <br /> Phone/E-mail .246 LS 756e It/i4/407- j '6GOW/ <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: J 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 /> b io Zt9'v. CYC P 4-msky 1404,9z- Mud b ET�-i 4 psi 4&' <br /> (( r,GS�s�YC 411-0 vs/ k�-lt1�OS-(Ce ©S /Le ' iSS!c .- A Z��r <br /> MECHANICAL PERMIT APPLICATION PLUM ING 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 j Lavatory(wash basin) <br /> Water heater Shower <br /> Gas fireplace Kitchen sink&disposal <br /> Gas range Dishwasher <br /> Clothes dryer Clothes washer <br /> Range hood Water heater <br /> Exhaust fan j Sink(service/bar/mop/etc.) <br /> Heat pump j Backflow preventer <br /> Unit heater I Urinal <br /> Boiler Drinking Fountain <br /> Refrigeration I Floor drain <br /> Woodstove Grease trap <br /> Ducting Roof drains <br /> Other i Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM j 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 /> 10/6/AVM/ <br /> Owner/Authorized Agent Signature Date (Revised 3/2013) <br />