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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 ADDRESS: PROPERTY TAX it PERMIT <br /> /A <br /> Ha11Y D R tLiP r &A�IB2 ";.7-'lOocXLto' P ( 1061 - ® re) <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER DO, R .tfi'f/c Phone/E-mail 7e)6 50-q- VtcrW//c'OOml&'IP'T1/41l•een <br /> Address tw /-I I L y p/ Eve-le--TI (JA'irli:Lf City/State/Zip E vae i T 12,91_ q p <br /> APPLICANT:_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 O1,�1 1U��- State Lic.# City Bus. Lic.# <br /> Address Phone/Email <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT p4 <br /> Phone/E-mail (/ lit& TIIdA/(Paz11ici/"tC7/1/ive La/ <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK # 3;eve.O(J <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building Gas ' Electric Other <br /> Building type: X 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(additionalnspace provided on the back): <br /> Dui-e- Peek fa Po* GOV Gd/dkI -Fah1L-�C J`'� /211X4-e_ - <br /> Q <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 I 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 I Backflow preventer <br /> Unit heater I Urinal _ <br /> Boiler Drinking Fountain <br /> Refrigeration Floor drain <br /> Woodstove ( Grease trap <br /> Ducting Roof drains <br /> Other j Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM I Other: <br /> Number of Heads 1 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. 1' <br /> re)/391./ /1////(7. <br /> Owner/Authorize ent Sign ture Date (Revised 3/2013) <br />