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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 ADDRESR. PROPERTY TA # P�MIT <br /> 72//,a/N/6-W_ Dl' # D o�3 4') e..)�� 1 /V I )T I I `U I(a <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER 41.-74- T T/i)��,3/0✓6 46/77/41/7-y Phone/E-mail VZ, Z5-2',. 472 G- <br /> Address p-12 0 X /'J / 7 City/State/Zip Z.7-1/676771 /4,f7 9ZZo <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 6/4 'State Lic.# City Bus. Lic.# <br /> Address Phone/Email <br /> TENANT BUSINESS NAME PV0 2 / y S CONTACT FOR M `/WA/ / /1-4-f/ <br /> //VSIK/ —,:e Phone/E-mail1'S So? <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK j9= zn <br /> Existing Use of Building J /‹ HEAT SOURCE: <br /> Proposed Use of Building Gas VElectric 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(additional space provided on the back): <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 /> nNumber 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 II a L'ori by t,-.wner 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 /> v--(y <br /> Owner/AuthyAgent Signature Date! (Revised 9/2014) <br />