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• • <br /> 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 ADDRESS: _l (�/ / l/I V J t � PROPERTY TAX# P MIT# �O <br /> LEGAL for new construction: Short Plat/subdivision 1 W Lot No. (attach copy of long legal description) <br /> OWNER NAI!'1(L4 %d �li ie w �'dU 0 hone/E-mail <br /> Address 2 6.-A YevV e Z' U-t-'-2 r tv,l City/State/Zip <br /> APPLICANT:_Owner _lOwner's Agent _Contractor _Contractor's Agent _Tenant(must provide a letter of consent from the owner to do work in the space) <br /> CONTRACTOR //J 7�r j..�' Z�L���/h'� .1.- State Lic.# �� �I ' QZ( !'G City Bus. Lic.# Q <br /> Address r 7 36) y ��r X re 4, y ' A L,,114 vim" v� Phone/Email <br /> TENANT BUSINESS NAME CONIIAgT FR P MIT <br /> � /ICYtC�1s�r <br /> Phone/E-mail �(� �Z� �i�',/L•� 1�I P� iG Lr <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK 61 <br /> Existing Use of Building Z" vv(-t)w. HEAT SOURCE: <br /> Proposed Use of Building r=1:nflv1c 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(additional space provided on the back): ` 1jc, '-C cL/ `�J ,A-, <br /> A C3 O'ltc, 'L1� C f 11t,w t� l�i'v <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 /> I Forced air systems Bathtub <br /> j Gas piping Lavatory(wash basin) <br /> 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 /> Heat pump Backflow preventer <br /> f 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 1 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 /> 4-kA/ <br /> Owner uthori ed Agent Signatur — Date (Revised 3/2013) <br /> 4 <br />