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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 /> i'\Y333 1`1 h YAC `'�L s� e I i.i) 6!503-0t 7 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER ` > (w\ C•. t 1411 i Phone/E-mail '4+0,55 —)33 y��_ X 1 3 <br /> Address 3 1 t1 1r4, E. tn,d"Z itw City/State/Zip t <br /> APPLICANT: Owner _Owner's Agent )r Contractor _Contractor's Agent _Tenant(must provide a letter of consent from the owner to do work in the space) <br /> CONTRACTOR fl(�,1?p4 +r1Nt any, �_. State Lic.# A 1r A I\)C' 1 ).3t1t1 11)City Bus. Lic.# "I 3359 <br /> Address (� r 11 I ) Phone/Email � j' Ca <br /> �� �`�k ��� �r;IYY`��lrlr'Z 1�. I��t�� � � �J <br /> TENANT BUSIN SS NAME / CONTACT FOR PERMIT <br /> Phone/E-mail &f'_3 *Am.mr€' CfrinT w t-tc'c:r*d r6<f3r$,. <br /> rro <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK 35(K.) • N") <br /> Existing Use of Building 'Mt 1 t c i c4 �^�-�^c j L 7t HEAT SOURCE: <br /> °i <br /> Proposed Use of Building I4 a 1 I (�T f I C_'-t Gas_ Electric_ 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 A ..`OF ORK(additional space providedlon the back): 6 c; ' n,�Gu, i'vl (--a( 5� p r <br /> "VrG�.I \ W l'+-61. 4 SIN r✓LG( eG)C1y +V-t;lt'I SM L�+ iVl �I�iu r r(%. Vt tl it:Ih IS �l <br /> vvL ex. (ci-t( <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 /> NC-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 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-1-a%authorized by th . ner of this property to perform the work for which appli ation is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> ,. 3'� ti` <br /> Owner/Authorized Agent Signatur ate (Revised 9/2014) <br />