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PERMIT APPLICATION <br /> BUILDING/MECH/-,NICAL/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 /> 71 AM Lf D- .,li:r J <br /> SITE ADDRESS: -.7RAJPROPERTY TAX# PFFMIT# <br /> UClin04 7-J09. IMbion o —l1 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> nnt.ilL �4a( <br /> OWNER rya Phone/E-mail S L <br /> Address City/State/Zip <br /> APPLICANT: Owner _Owner's Agent _ ontractor Contractor's Agent Tenant(must provide a letter of consent from the owner to do work in the space) <br /> CONTRACTOR State Lic.# ty Bus. Lic.# <br /> Address Phone/Email <br /> TENANT BUSINESS NAME 13� V4 CONTACT FOR PERMIT It� l <br /> kizeqo-0 1 Phone/E-mail . <br /> BUILDING'PERMIT APPLICA 1 N CONTRACT PRICE OF WORK <br /> Existing Use of Building HEAT SOURCE: <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.1. Sin Sprinkler Demolition Chane of Use <br /> DESCRIPTION OF WORK(additional space provided on the back):—R ��i5b <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: New_Addn Alteration_Repair Ty p of Project: _New_Addn _Alteration_Repair <br /> Show Number of fixtures Show Number # of fixtures <br /> A/C—air handling units Toilet <br /> Forced airs stems Bathtub <br /> Gas piping Lavatory wash basin <br /> Water heater Shower <br /> Gas fireplace Kitchen sink&dis al <br /> Gas range Dishwasher <br /> Clothes dryer lothes wash <br /> Range hood er heatof <br /> Exhaust fan Sink ice/bar/moP—!etc. <br /> Heat pump Bac o reventer <br /> Unit heater Udhal <br /> Boiler rinking Fount <br /> Refri erationFloor drain <br /> Woodstove _ Grease trap <br /> Ducting Roof drains <br /> Otheref A a iAp Medical Gas <br /> SPRINKLER I SUPPRES ON STEM Other: <br /> Number of Heads z 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 /> (oftwhether 'fled 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 au �e the o ner of this pro erty o perform the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> v 7 i <br /> uthorize I Agent Signature Date (Revised 9/2014) 1 �/ <br />