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• 110 <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# Pc RMIT# <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER C.:_(,_-t_-L ` Phone/E-mailb �3_ 680(1Address ,201 CID y H f6N[i W • c G �{1 d City/State/Tp ;, -,MM <br /> �, V1V�V}(O L .-4 1 ® (/ <br /> 9 <br /> APPLICANT: Owner (/uwner's Agent _Contractor _Contractor's Agent _Tenant(must provide a letter of consent from the owner to do work in the space) <br /> CONTRACTOR OWu. ( 'State Lic.# City Bus. Lic. # Qy7Y7/ <br /> , 0 7vp y N f}z/G W 3 G .2Y 0 <br /> Address _ 4•7 I.,oo r ctf 4 Q903 6 Phone/Email Y� 6 73-�ji 8b y <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT / c..."---d 1 <br /> (tee 0 <br /> C� \IC, Phone/E-mail c 2,S- C`/—t 1,--/ to Le0H,SI,cc47 ki e-c ),,(a., <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of Building `i.`c_«—t-.\-- HEAT SOURCE: <br /> Proposed Use of Building D.L,• — `` ` \_,,,-__ _,:_ `,_) Gas Electric t//Other <br /> Building type: Single Family Duplex Townhouse Multi-Family '2 Commercial // <br /> Type of project_ New Addition Remodel Repair_T.I._Sign Sprinkler ,,/DemolitionChange 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 /> 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 /> 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 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 n.. h 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 a horized by the own- ,elf thi 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 /> ( i <br /> /9//(7/ <br /> NIZ <br /> Owner/Au horized Agent S gnature Date (Revised 3/2013) <br />