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r ERMIT 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# PERMIT# <br /> •63O 5 ` 4vc- 111/x'✓ /.7, `% C 43/1 15dCi— DOI <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attachracopy of long legal description) <br /> OWNER %$ c!cz�✓� S Phone/E-mail 1 -3Y/ -3SC C,z e- <br /> 5 ate ,y/ �,�ys cow <br /> Address 5530 5 AVE L/, City/State/Zip i—Ve_rf,, //q <br /> APPLICANT: Owner ,Sc 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 Z � ��_k 1 !(/C; State Lic. # City Bus. Lic.# 7_2/II <br /> Address po gox 13 /3 L yiirlu/o0 V119 y vq Phone/Email y?S- " 51 o iceS54 <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Phone/E-mail <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK ;, �> �$ <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(additionalrspace provided on the back): / / n <br /> -1n5�ct—// l v Sr TcJd7- 577„, 5j-FT%� // -�fJ.If�a 2�i / d c`d,-n S'Icict,.,a,//� <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(inside bldg) <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 I SUPPRESSION SYSTEM Other: <br /> Number of Heads 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 WAC. <br /> —41-76 <br /> • ,ner/Authorized Agent Signature Date (Revised 4/2015) <br />