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PERMIT APPLICATION <br /> B U1 LDING/M EC HAN ICAL/PLUMBI NG/SIGN/SPRI N KLER/D EMOLITIO N <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 AD TS: PR PERTY TAX# PERMIT <br /> D Cot)� no 411 cr�� <br /> LEGAL for new construction: Short Plat/subdivision —Lot (attach copy of long legal description) <br /> OWNER, k� honeIE-mail C) - cr <br /> Address ! Icp ity/Stateizip <br /> APPLICANT:—Owner —Owner's Agent 4-Contractor —Contractor's Agent _Tenant(must provide a letter at consent from the owner to do Work in the space) <br /> CONTRACTOR Sf a" y\.a IStateLic.#N44An kA�qqj 12q City Bus.Lic.#DQ 8 g"-x 0 <br /> Address"'14�01 5 1 S 4-0- "?L �,s 1phonetEmail �Ivp -OQ q 9 - -1A C)fz:) <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT_)4A r^lt INTV�� <br /> Phorre/E-mail'%W YYN't--t-eDbil, C-0 <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of SuJOKng Gas --'�Electric Other <br /> 1' <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 /> DESCRI?TION OF WORK(a dilional space provided on th4back): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New—Addn —Alteration_Repair Type ofProject: _New_Addn _Alteration_Repair <br /> Show Number(N)of fixtures Show Number(#)of fixtures <br /> AIC-air handling units i Toilet <br /> Forced airs stems Bathtub <br /> Gas piping Lavatory(wash basin) <br /> Water heater Shower <br /> Gas fireplace Kitchen sink&disposal <br /> Gas ran ge Dishwasher <br /> Clothes dryer Clothes washer <br /> Range hood Water heater <br /> Exhaust fan Sink(servicelbar/mop/etc) <br /> Heat pump Backflow preventer <br /> Unit heater Urinal <br /> Boiler Drinking Fountain <br /> Refrigeration Floor drain <br /> Woodstove Grease trap <br /> Ductin I Roof drains <br /> Other Medical Gas <br /> SPRINKLER I SUPPRESSION SYSTEM <br /> Other: <br /> Number of Heads C 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 w!l1 bn comp <br /> h I red 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 /> �h whether <br /> I authorized <br /> lul r,specified <br /> d b y the a w of this property to perform the work for which I' lion z made and I comply with the State Contractors Law 18.27 RCW and 2.96,200A WAC <br /> � I"s jpP Ica <br /> i I-�- <br /> 4'n.A,1Authbrfzed Agent Signature . UdM (Revised 912014) <br />