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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.# PE IT# - <br /> 72i/'ie/f /f//6,eDe Ze7/. &7- 9i'Zo3 eU3750n606F3dI 19a-0717 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER r,c, 7T,$�/f%r7/`e. 146/7;017/7"-Y Phone/E-mail c7/5T 25 9z2..- <br /> Address 310 7 COLEY Ave t-*7.67r City/State/Zip l- 77/71W-Tf,6tW <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 /> Phone/E-mail etz� 6397 "(/A/0C117-7/1.OA6 <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK 1&', ,S 7 -- <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building Gas Electric Other <br /> Building type: _Single Family Duplex Townhouse _Multi-Family _Commercial <br /> Type of project: _New Addition _Remodel Repair_Ti._Sign_Sprinkler Demolition Change of Use <br /> DE <br /> CRIPTION O F WORK(additional space provided on the back): <br /> i <br /> / <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 /> J A/C–air handling units 1 Toilet <br /> Forced air systems J Bathtub <br /> Gas piping Lavatory(wash basin) <br /> Water heater Shower <br /> Gas fireplace J Kitchen sink&disposal <br /> J Gas range Dishwasher <br /> Clothes dryer J 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 /> J Boiler Drinking Fountain <br /> Refrigeration Floor drain - <br /> Woodstove Grease trap <br /> J Ducting Roof drains <br /> Other Medical Gas <br /> SPRINKLER I SUPPRESSION SYSTEM Other: <br /> I 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. <br /> ‘f ( <br /> it,/ <br /> 'Owner/Aut Ji ed Agent Signature Date (Revised 3/2013) <br />