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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 ADjE S: �,, 2 PROPERTY TAX# PERMIT# <br /> �o� �sIN0ever �6 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER ��rt(�/�7 c p Z Phone/E-mail <br /> ? /1 Gtc7 r1 7 ry <br /> Address I© W L TI CT N 1 J 0 1A"B J City/State/Zip <br /> APPLICANT:--k 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 —r•u �,: J—` C-�1u�1 State Lic.# LLFViEj,KJ&; 11 (— City Bus. Lic.# 64-t3 59 <br /> Address Phone/Email <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> 3 DME, gas-.?-3$-v11'1S <br /> Phone/E-mail MJ <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of Building M F& HEAT SOURCE: <br /> Proposed Use of Building M F& Gas Electric Other_ <br /> Building type: _Single Family _Duplex_Townhouse _Multi-Family )( Commercial <br /> Type of project: _New _Addition 9 Remodel _Repair_T.I._Sign_Sprinkler_Demolition_Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> C,vZ►r►Bi,u itiG ✓s't U: T1)'[. S�f)ri2J n� L�terrn. OhNiE- t✓ EK 7A>NlNC ��•' iti <br /> Rcegu Esr fiA nEi7)0 rfeM1r aNt✓r 97-TNir 77A)6- <br /> Z2 . <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 Lavatory(wash basin) <br /> Water heater Shower <br /> Gas fireplace Kitchen sink&disposal <br /> Gas range Dishwasher <br /> Clothes dryer Clothes washer <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 /> Refrigeration Floor drain <br /> Woodstove Grease trap <br /> Ducting Roof drains <br /> Other I Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM I 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 /> /zZ S� Vo- <br /> Owner/619fioriied'Agent <br /> Sign ure Date (Revised 3/2013) <br />