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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: ,.(.tt <br />l61s'7S� 5t"5w S� e 210 <br />PROPERTY TAX # <br />�t(IIvC3►ofIc3c� <br />PERMIT # <br />LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br />OWNER Ve-' Ter 6 pckjt :JC <br />S <br />Phone/E-mail <br />Address m SI I joi+ NUF-W 4'3 <br />`Qi)3Ew%Q <br />APPLICANT: Owner _ Owner's Agent K Contractor _ Contractor's Agent Tenant (must provide a letter of consent from the owner to do work in the space) <br />CONTRACTOR e SI' �� AaV l,,silck <br />State Lic. # � E-City Bus. Lic. # <br />�C <br />Address6os 9wY clq S, �J+L\ �WU �U � i� <br />Phone/Email.lT' �2 �132�rt�l�ulCYe1Sl Gt.�i <br />TENANT BUSINESS NAME <br />r r- <br />CONTACT FOR PERMIT i'� ( LY Ac <br />3&"-t(2k-t35 2 <br />Phone/E-mail %. fl "2YQ�'S/ . c-3 <br />BUILDING PERMIT APPLICATION <br />CONTRACT PRICE OF WORK SJ Ot3C:3 [Ov <br />Existing Use of Building UT(Pt[�� <br />HEAT SOURCE: <br />Proposed Use of Building c..0 <br />Gas Electric Other <br />Building type: Single Family _ Duplex _Townhouse _ Multi -Family _ Commercial <br />Type of project: New Addition Remodel Repair T.I. X Sin Sprinkler Demolition _Change of Use <br />DESCRIPTION OF WORK (additional space provided on the back) : <br />Rep6rf eg51Ft`3 JAA01-t.v11-IA- - St <br />MECHANICAL PERMIT APPLICATION <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _New <br />Show <br />_Addn _Alteration _Repair <br />Number (#) of fixtures <br />Type of Project: _New <br />Show <br />_Addn _Alteration _Repair <br />Number (#) of fixtures <br />A/C - air handling units <br />Toilet <br />Forced airs stems <br />Bathtub <br />Gas piping <br />Lavatory (wash basin <br />Water heater <br />Shower <br />Gas fireplace <br />Kitchen sink & disposal <br />Gas range <br />Dishwasher <br />Clothes dryer <br />Clothes washer <br />Range hood <br />Water heater <br />Exhaust fan <br />Sink (service/bar/mop/etc.) <br />Heat pump <br />Backflow preventer <br />Unit heater <br />Urinal <br />Boiler <br />Drinking Fountain <br />Refrigeration <br />Floor drain <br />Woodstove <br />Grease trap <br />Ducting <br />Roof drains <br />Other <br />Medical Gas <br />SPRINKLER <br />/ SUPPRESSION SYSTEM <br />Other: <br />Number of Heads <br />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 comp <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 WAG. <br />Owner/Authorized Agent Signature Date <br />(Revised 912014) <br />