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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 /> [ o l-O IZ <br /> SITE ADDRESS:' /� � ) PROPERTY TAX# P MIT <br /> -1 AC— � �/C l o f- Q <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER Phone/E-mail —I <br /> Address Ot-r City/State/Zip t; ; I l �TCJ <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 1-` ` _ t ',' ;_ �., ' State Lic.# ( ,: ,J -k,� City Bus. Lic. # <br /> Address 'j i <br /> Phone/Email )) / <br /> - i ikPJ �� +. y to ✓� _ <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> �,'r\ �CA✓''15��;' X25=1 ��-S 2�4- <br /> Phone/E-mail = _,t V_(41 = -:7 tJ ,y xP-A-7--kr_tj ice' <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK 3c5 oov <br /> Existing Use of Building Ay rhe ti"-, S HEAT SOURCE: <br /> Proposed Use of Building Gas Electric X 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): <br /> ko-;L, Lf03, Salo 30 3, aot, 4ROCR it-a0-3 <br /> f. , <br /> MECHANICAL PERMIT APPLICATION PLUM"I-91PERMIT APPLICATION <br /> Type of Project: New_Addn _Alteration_Repair ype of Project: _New_Addn _Alteration Repair <br /> Show Number(#)of fixtures Show Number(#)of fixtures <br /> A/C-air handling units v. j Toilet <br /> I Forced air systems `' Bathtub <br /> Gas piping j Lavatory(wash basin) <br /> Water heater j Shower <br /> Gas fireplace j Kitchen sink&disposal <br /> j Gas range Dishwasher <br /> Clothes dryer Clothes washer <br /> Range hood Water heater <br /> Exhaust fan Sink(service/bar/mop/etc.) <br /> i Heat pump I Backflow preventer <br /> Unit heater Urinal <br /> Boiler Drinking Fountain <br /> Refrigeration j 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 t ed 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. t <br /> OwnerrAuthorized Agent Signature Date (Revised 3/2013) <br />