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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 ADT ESS' _ j /� PROPERTY TAX# PERMIT# <br /> r FIS N- l l"-t(,% 1.�(r, —0 0 3 <br /> LEGAL for new construction: ShortPlaYsu`b/�d.ivision Lot No. (attach copy of long legal description) <br /> OWNER A M F(IA / 11(O(>- 02 A- Phone/E-mail A C� M A It � 6 CCJM <br /> Address 0 V'- etor-e A� �(r' �t-f t� City/State/Zip FFV-tR EfLA,/A cp?o I <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 h �'I t C ( nt! (.(( CI 6&-- State Lic.# <br /> IPACity Bus. Lic.# <br /> �G i 7 k':yi71i)1 b✓1,1�� C 0` , O bk11 AA.1 V A.i i LF c, i=i1�i C L�li- C c)/L i <br /> Address U 1-��yt,.i) ). (,L: �O' .L Phone/Email � � �t�FS <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT if �S-_ ,C I y <br /> IA Phone/E-mail J topd r S hof c o v CUA <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK 000 <br /> Existing Use of Building { S%t(J);�1,}-i/a HEAT SOURCE: <br /> Proposed Use of Building 6<I-S f OFF-"-A Gas Electric _ Other F-o <br /> Building type: V_Single Family _Duplex_Townhouse _Multi-Family _Commercial <br /> Type of project: New Addition Remodel Repair_T.1._Sign_Sprinkler_Demolition_Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> w4ler- l00Y/ boifi "m-- loor <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 /> A/C-air handling units Toilet <br /> Forced air systems ; Bathtub <br /> Gas piping j Lavatory(wash basin) <br /> I Water heater j Shower <br /> Gas fireplace Kitchen sink&disposal <br /> Gas range j Dishwasher <br /> Clothes dryer Clothes washer <br /> Range hood Water heater <br /> Exhaust fan Sink(service/bar/mop/etc.) <br /> I Heat pump Backflow preventer <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 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 /> EP 3 ?pry l <br /> -'Uw-neftAuthorized Agent Signature Date (Revised 3/2013) <br />