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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 /> SES fir ©�I PROPERTY TAX# PF iMI <br /> /)66 ! oma,, s.)- --'4e./ c`/ �$ co, 1 ' c -00 1 <br /> LEGAL for new construction: Short Plat/subdivision Y Lot No. (attach copy of long legal description) <br /> OWNER <br /> OWNER, (r./los eGOAt; i 10.. Phone/E-mail © 10 - *5 2 7— L1 S q <br /> Address NC*1iti__..<_ City/State/Zip <br /> APPLICANT:/?wner 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 r sr ©(J'1- -- State Lic.# City Bus. Lic.# <br /> Address Phone/Email <br /> TENANT BUSINESS NAME CONTACT FO <br /> PERMI O• ,Lys 7 7� J� I <br /> 7f d i�i�� <br /> Phone/E-mail AOC _ ``T3q44 ----‘1-(5--7 1 <br /> q 1 <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK /7, r/(.'7;q <br /> (' ji <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use ofBuilding '4yc.,,,,cj f�A. Gas . Electric Other <br /> • <br /> Building type: f/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 OF WORK(additional s ace provided on the back): e <br /> r uA�� �`1.6Yeci-e- e Gam'hroWA. �' �4�- <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 _ / I Lavatory(wash basin) <br /> Water heater _ j Shower <br /> Gas fireplace ( Kitchen sink&disposal <br /> Gas range Dishwasher <br /> • <br /> Clothes dryer j Clothes washer <br /> Range hood f Water heater <br /> ! j Exhaust fan /` Sink(service/bar/mop/etc.) <br /> Heat pump Backflow preventer <br /> Unit heater i 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 j 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 /> 1c(— / a <br /> Owner/Authorized Agent Signature Date (Revised 3/2013) <br />