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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: PR PERTY TAX,If PE IT <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER t-,F29� 1/f/f,// ,rr6/7;4/e///r y Phone/E-mail SZ.5—e. 922- <br /> Address 3/b)-7 z,69Yd(�e'! 6,ej% r City/State/Zip Z'O /i./.1 <br /> I <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 State Lic.# City Bus. Lic.# <br /> Address Phone/Email <br /> TENANT BUSINESS NAME,/ CONTACT FOR PERMIT,/ <br /> // Vr A Phone/E-mail 0n �G•t 39 ' /�C3/(4/1! [t�`L j'7✓x.ela-; <br /> BUILDING PE MIT APPLICATION CONTRACT PRICE OF WORK 2c 7Z <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building Gas IVElectric_ 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 /> DE CRIPTION OF WORK(additional space provided on the back): <br /> - i_ - /1/6w S-/ -7//116 , /i/E7-4/ Z.t✓/,✓.Oe) ',v 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 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 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 /> 't/z <br /> Owner/Aut of d A ent Si nature /j D <br /> 1 � <br /> g g a4e (Revised 3/2013) <br />