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PERMIT APPLICATION 6 <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 PERMIT# <br /> 72aiel//v D, <br /> /67€ e eer4r '�T 96rzo3 ov 3 A # Dbt�C�e'30I e2[4oq' 07A <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER t' 77-,Q/f///G ,4U%�Qr '7 V Phone/E-mail 0Z3�2$`---s). 92Z 7_ <br /> Address ?/e)71�Q�,V/Ie t ? ' /7- e'-‘,"'re-77,-/s14 <br /> City/State/Zip <br /> 'Owner 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/re,/ , ,4- ' ,/ <br /> Phone/E-mail 7l'cce t?3977 /la &n,f/-i4.6,6 <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK_ Z ...S.'-.7 2_ <br /> Existing Use of Building_ HEAT SOURCE: <br /> Proposed Use of Building Gas_ Electric Other <br /> Building type: Single Family Duplex_Townhouse 1/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 /> DESCRIPTION,4/Yl v6 NEW , ')o,/- /l"t V S/a//v6 , /ve—e /,ii' ui S <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 /> A/C-air handling units l Toilet <br /> Forced air systems I 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 I 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 /> 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 /> old 0)V \`y, <br /> 'O ner A A / / <br /> w / u ed gent Signature Date (Revised 3/2013) <br />