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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: } E, z t PROPERTY TAX II PpERMIT# <br /> ST. IP\SS ` zeo 2-00H 02.60 4U(D - oa-S <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER 1 RAJ $ 5€gt.oaie ieyrflL <br /> Q k -pSEpW�V� B U S I N i) 1A Phone/E-mail 25�-0 6 -509 3 Pt1,,)eER-rt GF S • C , <br /> Address •I I Cv B r�AC�k�-Ft"' f I) I? �J t�ei City/State/Zip I H J��IJo(? L),� 76 ?- <br /> APPLICANT: <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 iencn. it 1AJI Ie-I-tet State Lic.# City Bus. Lic.# <br /> Address - r' Phone/Email _ <br /> TENANT BUSINESS NAME r L uNrACT FOR PERMIT <br /> ,M A wE i2-£S 5£ obcLPcia,p'T t 0�j ! 1 s C ,r-) <br /> livk55LC Phone/E-mail cyZS LI-j Ste) 2 C10t-U"J�}NSQ1.OQb <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK 39 SC)W <br /> Existing Use of Building 1,.)%‘14_£1-k HEAT SOURCE: <br /> Proposed Use of Building SA h1 Gas Electric Other <br /> Building type: Single Family Duplex Townhouse _Multi-Family X 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 /> A cl 0 S <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 j Shower <br /> Gas fireplace Kitchen sink&disposal <br /> Gas range I 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 Urinal <br /> Boiler I Drinking Fountain <br /> Refrigeration j Floor drain <br /> Woodstove ! Grease trap <br /> Ducting Roof drains <br /> Other Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM I 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. 1' <br /> --�� 512-C �/ /?r/ 9 <br /> Owner/Authorized Age Signature Date (Revised 3/2013) <br />