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PERMIT APPLICATION <br /> BUILDING/MEC HANICAL/PLUMBING/SIG N/S PRI NKLER/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 /> t�;G��y C��IrJ7' WAY Z-90I I Q1G00 4` <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER jC:L( t),k t t3C)Nt:: - CL L/ Phone/E-mail rj g�(�j –5,848 <br /> Address C,609 eLL1 — W N City/State/Zip 1✓Yt_� <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 5 j- ` /LI r1 State Lic.# 0jt rLj�'G -941(itlG City Bus. Lic.#QS 7C <br /> Address Phone/Email <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> i' Ve6t&tJ (,t t4 eg <br /> Phone/E-mail 1<1 Ry, ?,,!r ©531 <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of Building &AP%/`2EC F-e�)M HEAT SOURCE: <br /> Proposed Use of Building 15AIdli"Ir. Gas Electric Other <br /> Building type: X,Single Family _Duplex_Townhouse _Multi-Family _Commercial <br /> Type of project: New Addition Remodel Repair T.I. Sin_Sprinkler Demolition Chane of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> �«•.t J e.�eT Eac�Ott*�� ca.��, a�.� t� • -- - 5 P,sc.E� s,n.rm <br /> AUD eoa esec�-rr�s vet ge.&. - <br /> 2. S acmes <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT PPLICATION <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 /> A/C–air handling units 1 ! Toilet <br /> Forced airs stems Bathtub <br /> Gas piping Lavatory(wash basin <br /> Water heater Shower <br /> Gas fireplace C Kitchen sink&disposal <br /> Gas range Dishwasher <br /> Clothes dryer Clothes washer <br /> I <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 /> 1 <br /> Refrigeration Floor drain <br /> Woodstove ! Grease trap <br /> Ducting Roof drains <br /> Other Medical Gas <br /> SPRINKLER/ SUPPRESSION SYSTEM ( Other: <br /> 'lull 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's <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 applicatiTh is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> Owner/Authorized Agent Signature Date (Revised 9/2014) <br /> 21 <br />