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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: PROPERTY TAX# PERMIT <br /> .4(ok ' ojc-On5;-, Eveutf Cz#iQ ion DOB l.;(-71 f cloa(pOD <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER 100.1. ncjt �dk C elci-) Phone/E-mail <br /> Address 4 ,ro City/State/Zip �kje_,l-.u- l uJ , gcfs DI <br /> APPLICANT:_Owner _Owner's Agent ?p Contractor _Contractor's Agent _Tenant(must provide a letter of consent from the owner to do work in the space) <br /> CONTRACTORS kr�t��Z l��u vv. 41, 4) State Lic.# ;( Fp q 7,5 L(City Bus. Lic.# <br /> Address F3 Li or �S- wct -I wa 5/t Ohio-111C' <br /> 1Y7v m /i Phone/Emaill2.5-9S5-0SA <br /> TENANT BUSINESS NAME / CONTACT FOR PERMIT <br /> Phone/E-mail/ ,cif C adokeA( ft ' m <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <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 4Remodel Repair T.I. Sign_Sprinkler Demolition Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> • <br /> 4 ko li \ W (tut ) a - �u.. ( Cm c( -C s <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New_Addn Alteration_Repair Type of Project: _New_Addn }C 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 f 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 wit 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 Lam 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 /> fs <br /> (Fl t - / � /L� <br /> Owner/Authorized ent Sig ature Date (Revised 9/2014) <br />