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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 ES ' 5 � �/ 1 , <br />PROPERTY TAX # <br />PE MIT # J <br />oq <br />LEGAL for new construction: Short Plat subdivision Ii I i�rdo of o.� (attach copy of long legal description) <br />OWNER V&Vt44-1W 1. l { E. LLC <br />Phone/E-mail <br />® f ew5 <br />Address <br />Y i <br />C' /State/VWN <br />Ito <br />APPLICANT: Owner Owner's A ent Contractor Contractor' Agent _Tenant (must provide a letter of consent from the owner to do work in the space) <br />— —— <br />CONTRACTOR V <br />State Lic. # f1 <br />r.�t <br />A R L� Y� t_ City Bus, Lic. # u <br />Address <br />Phone/Email <br />TENANT BUSINESS NAME <br />CONTACT FOR PERMIT s� f'�-rau <br />g tv <br />�aMdlS •, r <br />� Jn�°`ei�3 xIG <br />Phone/E-mail V <br />BUILDING PERMIT APPLICATION <br />CONTRACT CE OF WORK <br />Existing Use of Building HEAT SOURCE: <br />Proposed Use of Buildin6 , Gas_ Electric( Other_ <br />Building type: _ Single Family _ Duplex _Townhouse & Multi -Family _ Commercial <br />Type of project _ New Addition Remodel _X Repair _ T.I. Sign _Sprinkler __Demolition_Change of Use <br />DESCRIPTION OF WORK (additional space provided on the ba k): -khe, fie ei;•»f��tIY%/I'lGt�Q�S <br />1�/ <br />Alm e" vr- a,7al <br />• -vsss � will be, ; asf'a.6I ed and -this lyl of Y"L-hut lt; <br />MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br />!Type <br />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 i 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 />Ducting Roof drains <br />Other <br />I <br />Medical Gas <br />SPRINKLER <br />/ SUPPRESSION SYSTEM <br />I <br />Other: <br />Number of Heads <br />I <br />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 compliec <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 />QM� e. P"Aj�Z <br />cell�r Authorized Agent Signature t Date <br />l /Z <br />(Revised 312013) <br />