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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 ADDRESS: PROPERTY TAX# PERM <br /> 3 -K PKLA- 200 �Oc>� �� (�� Lcc T <br /> C 0 . <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER — Phone/E-mail CA r ftAS5A y-i e &A 7,,-C" G o►1, <br /> Address i231 C W Z7 q City/State/Zip E-11UQ L7 4r`A - -7C,Zo <br /> APPLICANT: Owner _Owner's Agent X Contractor _Contractor's Agent (_Tenant(must provide a letter of consent from the owner to do work in the space) <br /> CONTRACTOR O� '-V., C �C State Lic.# ( 6(( tt(4 DC 0O PM City Bus. Lic.#0- 4�2-- <br /> Address -(aST, ST-C Srua Rom(S H "ln �tz5-z'ra-2 3 <br /> i�2—i� Phone/Email <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT CA9SLJ ELL <br /> Z3'�-� <br /> t Phone/E-mail S}^� C rL Y'S W 2 R 6 1A6 Y+6 IGti^C COK"�Y� <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK - e-1m <br /> Existing Use of Building 4 A)­1 f _ � 0U HEAT SOURCE: <br /> Proposed Use of Building Gas-X Electric Other <br /> Building type: _Single Family _Duplex_Townhouse _Multi-Family -K Commercial <br /> Type of project: New Addition Remodel Repair . T.I.—Sign_Sprinkler Demolition Change of Use <br /> DESCRIPTION OF WORK(additional space proved on the back): <br /> C.v-r rK-(E—� f( 6 �� � � tz � C�n�s�. 2 f o!OCAAS <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 /> i A/C—air handling units Toilet <br /> Forced air systems j Bathtub <br /> Gas piping Lavatory (wash basin) <br /> Water heater Shower <br /> I Gas fireplace ! Kitchen sink&disposal <br /> Gas range Dishwasher <br /> Clothes dryer j Clothes washer <br /> Range hood Water heater <br /> Exhaust fan I Sink(service/bar/mop/etc.) <br /> Heat pump Backflow preventer <br /> Unit heater Urinal <br /> Boiler Drinking Fountain <br /> Refrigeration Floor drain <br /> j Woodstove Grease trap <br /> Ducting Roof drains <br /> Other j Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM j Other: <br /> I Number of Heads F 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%,wJ3Aktherecified hereir 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 /> Thate <br /> 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 /> N <br /> Owner uthorized Agent Signature Date I (Revised 3/2013) <br />