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,r_ <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: PR PERTY TAX,# P MIT# <br /> 72-ilrff/N/(7,W. ,`747(77 '912 e, a 375/��n-60thr,� / 0)(F0-D <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copyy of long legal description) <br /> OWNER f rete .� 2W6 6/ A C/T7/4 /t V Phone/E-mail 23rC2,. 922_ <br /> Address3'/e07 CPtS Y ,9(/t (ft'j6'z7 City/State/Zip 44-0-77/-7,7;114 <br /> APPLICANT: I 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 State Lic.# City Bus. Lic.# <br /> Address Phone/Email <br /> TENANT BUSINESS NAME CONTACT FOR "�� f„ <br /> PERMIT ”, p <br /> / <br /> Phone/E-mail�Gn �6/C igLo /6W/VOz7-ti X.cV <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK— L�S i <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building • Gas Electric_ 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 /> ,/`, '• Or /i o i /1/6.Gr/ / 2//t✓6 4/c / Z,///✓.L'7(t 4/ <br /> . --- (k_ ie ,61(r/fri c'L' ..14 , -I " - . ' �" -- <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 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 /> \ V <br /> /<� d O ?XVI/ <br /> OwneAgent Signature <br /> Date (Revised 3/2013) <br />