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• i <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 vwvw.everettw org <br /> SITE ADDRESS: PROPERTY TAX14 PEWIT# <br /> 5430 C rimexcilL AVCr 6veitErr, w/� MA) [�05 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER I NES TJ NORA Phone/E-mail /1, <br /> Address 5630 60141464C/4c Aub, City/State/Zip &vb 2E Ti W i1 _`x.203 <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 (,t) State Lic.# City Bus. Lic.# <br /> Address Phone/Email <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> JON 4A P/ERRE <br /> Phone/E-mail C2o6) ciei 2 - 4995 <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK , U OD <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building Gas Electric f 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 /> REPLACE FOR.NACE AND MUT WAr€R Nr.' <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 /> V Forced air systems Bathtub <br /> Gas piping Lavatory (wash basin) <br /> '7 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 • Sink(service/bar/mop/etc.) <br /> Heat pump Backflow preventer <br /> Unit heater Urinal <br /> Boiler Drinking Fountain <br /> • <br /> Refrigeration Floor drain • <br /> Woodstove Grease trap <br /> Ducting Roof drains <br /> Other Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM Other: <br /> Number of Heads I Other: <br /> I nereby 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 /> jtvia 8/623/N <br /> Owner/Authorized A ent Signature Date (Revised 3/2013) <br />