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• <br /> PERMIT APPLICATIUII <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 RMIT# <br /> I 7 ll - 1/ -t f'1O - n(`) <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of!Ong legal description) <br /> OWNER C ,; 7 y 1 L Phone/E-mail Y% "i %� r /� / 1 <br /> p <br /> Address / / // lj r'f h-E sf C'cc li H k-1Y City/State/Zip ^ F- /4( // 1 •iA '%<>C' ( ) <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 7 , c• ,-1 7-7 , < ,-, / -- ,,, cState Lic.# ( .,- '7 57 . 2''/ City Bus. Lic.#C)c. f E 7 f <br /> • <br /> Address / /: :/ /// 7 <^--// (-• // L,:'7 /c.- - i.; Phone/Email•/. ( ;.< 1 cfc;,, /. <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT - 1 <br /> �'-' <br /> Phone/E-mail • <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of Building (A�� HEAT SOURCE:a � <br /> Proposed Use of Building 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 OF WORK(addition 1 space provided on the back): <br /> • <br /> R e I l a c e t�c(_ 7-c r p ;i ; ,tet c -t- 5 f 0 (-A./ e r_ V ae l v e 5 ' rr <br /> •un f5 /3 / O6) ,90 ) 53oC -1- api e- Y 1er ; 0,-- Af, 5e6 ; 66 <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 I Shower <br /> . Gas fireplace Kitchen sink&disposal <br /> Gas range Dishwasher <br /> Clothes dryer Clothes washer <br /> I Range hood Water heater <br /> Exhaust fan (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 I Grease trap <br /> I Ducting I Roof drains <br /> Other Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM L Other: J / c,."c r \J(-/c 1/r' ,--, <br /> Number of Heads / Other: l"-1 C- c l) . 6 4 <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 /> _________iz____ ___.- -- / ',1 - /5- <br /> Owner/Authorized Agent Signature Date (Revised 4/2015) <br />