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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# P MIT <br /> ZLEGA �' °lei ±)&''.�5 s -7,Z5-fes/3 6% ( / ®‘a-®CI- <br /> LEGAL <br /> L for�ne/w construction: Short Plat/subdivision �� / Lot No.__ (attach copy of long <br /> g legal description) <br /> OWNER V/r5 /� / G/�!/ L/�'1 r�J S/'C!J 7/�d Phone/E-mail . 5- 52 eQ/lD(Q/ 1749,-ke-f-2 //6(? .�O/G/ <br /> Address g�� 3 ��! ��, / City/State/Zip yore(/ ��j),4 <br /> APPLICANT: 1--"Owner _Owner's Agent _Contractor _Contractors Agent _Tenant(must provide a letter of consent from the owner to do work in the space) <br /> CONTRACTOR Muir ,�7/-e/ L& I Lic.# COE Bus. Lic.# <br /> Address Phone/Email /t//Llh/t � D <br /> DlrajCon-6'C� <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Phone/E-mai( t/ ' c2--J (7/1,(, <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of Building 17Z5/ a"e',,7�Cc-( /B/1 HEAT SOURCE: <br /> Proposed Use of Building /t? Y-/h- /1€ <br /> p G���Z'(��rj'1!/!� Gas Electric 1----Other_ <br /> Building type: " Single Family Duplex Townhouse _Multi-Family Commercial <br /> Type of project: New i...‹Idition Remodel Repair—T.I. Sign Sprinkler V6e.molition 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•ddn _Alteration_Repair Type of Project: _New do _Alteration_Repair <br /> Show Number(#)of fixtures Show Number(#)of fixtures <br /> A/C-air handling units i j Toilet <br /> Forced air systems Bathtub <br /> Gas piping % Lavatory(wash basin) <br /> Water heater j Shower <br /> Gas fireplace 1 Kitchen sink&disposal <br /> Gas range I Dishwasher <br /> j Clothes dryer Clothes washer <br /> ,► Range hood I Water heater <br /> -> Exhaust fan I Sink(service/bar/mop/etc.) <br /> Heat pump / ( Backflow preventer <br /> '2 I Unit heater Urinal <br /> Boiler Drinking Fountain <br /> 1 i Refrigeration I Floor drain <br /> Woodstove I Grease trap <br /> Ducting '� I Roof drains <br /> Other Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM i 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 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 /> Owrtc Authorized Agentent S� Date (Revised 3/2013) <br />