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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: 1.y 2,t 'i';;.,COr. Let c tt a PROPERTY TAX# P RMIT# _ <br /> EJP« tk- ; ‘i O zitlal act 042.c 004 Q0400 01�1 0-- WS <br /> LEGAL for new <br /> construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER l.,' 1 Oc- E vefe Phone/E-mail <br /> Address City/State/Zip <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 I Q '4-4``C 1:::k State Lic.# City Bus. Lic.# <br /> Address <br /> fV`�"'�,>3 1Pho e ma n /E it <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT f�_ <br /> Phone/E-mail UZ c LS') Oi .4(7 <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK i 401 <br /> Existing Use of Building I�L HEAT SOURCE: A <br /> N LI <br /> Proposed Use of Building S eiCaAJ2. i,ri.t.. fv,c.�� F) V 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 OFWORK(additional space provided on the back): <br /> I -IL; .,1 J., � v� ,, �, t�,o:)jL U Sew c @0) J 1�c-ki v? I -i� � <br /> �c►``� O J e' 4.-i., o rc �& & L Lii L104- EwfcW (JOIN- kes ,, <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 i Water heater <br /> Exhaust fan Sink(service/bar/mop/etc.) <br /> ( Heat pump Backflow preventer <br /> Unit heater I Urinal <br /> — <br /> Boiler ( Drinking Fountain <br /> Refrigeration ; Floor drain <br /> Woodstove Grease trap <br /> Ducting Roof drains <br /> Other I Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM Other: <br /> 1 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 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 /> 16/Z/ '� . <br /> wner/Authorized Agent Signature Date (Revised 3/2013) <br />