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• <br /> rRMIT APPLICATIO <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 /> iia /4" w & <br /> SITE ADDRESS: PROPERTY TAX# P MIT# <br /> -, :-.---)-7-)4t` /O :3'^,-F s7 5- O s3.�zO(.^C�6. 5-c e• I.SiO -®O <br /> LEGAL for new construction: Short Plat///771.1.4,5-& <br /> subdivision !/ Lot No. (attach copy of long legal description) <br /> OWNER J � G`' a //7 i ac 1y (1010(Ntc Phone/E-mail s-(L�"`1?2-/ d' f O n i %c. `j-///vG �✓ <br /> r / City/State/Zip &'12 (,t. )1'1A/(''th)'.1 <br /> Address P O �o� ��� �( `(�Lo L <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 1)7 yl 4_5 tiy Chierk AV /"9 C . State Lic.#O y k¢J 4/ f v/c5 5—City Bus. Lic.# <br /> Address f/ i' /7oy. 7/� e1J 1,,c...›..T. 7orz 'Z Phone/Email tar-y2Z-/(61-6-- _j<"rQ;,. <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Phone/E-mail <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of Building le./.4 HEAT SOURCE: <br /> Proposed Use of Building =sr �4 D✓rC )< 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 /> DESCRIPTIO OF WORK(additional space provided on the back): <br /> COK.s ' . N2 w 4°'x <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project::,k._New_Addn _Alteration_Repair Type of Project: XNew_Addn _Alteration_Repair <br /> Show Number(#)of fixtures Show Number(#)of fixtures <br /> A/C-air handling units 41= Toilet <br /> Zi Forced air systems `L- Bathtub <br /> (r, Gas piping Lavatory(wash basin) <br /> 'Z_- Water heater 2_ Shower <br /> '2.-- Gas fireplace 2__ Kitchen sink&disposal <br /> -- Gas range Z, Dishwasher <br /> 2- Clothes dryer 2 Clothes washer <br /> L. Range hood Water heater <br /> Y Exhaust fan Sink(service/bar/mop/etc.) <br /> Heat pump Backflow preventer(inside bldg) <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 I am authorized by the owner of this pro.erty 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 /> L1110 ' <br /> Owner/Aurr•rize 'went Signature Date (Revised 4/2015) <br />