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PERMIT APPLICATION <br /> --�tf�-�-���--�=��1 <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 q PERMJ� Z <br /> 2.70Z GOL� l/�•�-VE2�`�, •9�L�1 OQ43 1�62��300.0 5 — <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER ����.1--'��7 �j'���� Phone/E-mail '�'e1Z1,.5�1�jQ,Y1Q� 125�Gt,v�k��RJQ•CAIYI <br /> Address ��g �Q��� �j� (��'�i� City/State/Zip �y�b.�� ��-, �j�jZ <br /> APPLICANT:_Owner _Owner's Agent ✓Contractor Contractor's Agent _Tenant��,�si�,�o��ae�iene�or�o�se�i r�om ine ow�e�i�a�w��k��ine spa�e� <br /> � � V <br /> CONTRACTOR 1-�.' �J . State Lic.# ty Bus. Lic.# I l[% <br /> Address Phone/Email <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> �L���(�s �c111k- �,�LLI SMr� �"�`"" <br /> Phone/E-mail ��`$ Q� K.C1l���,��1�� <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK I � ?C-%t�, C'C�C� <br /> Existing Use of Building '����e.� HEAT SOURCE: <br /> Proposed Use of Building �`'�k Gas� Electric Other <br /> Building type: _Single Family _Duplex_Townhouse _Multi-Family �C Commercial <br /> T e of ro ect: New Addition Remodel Re air T.I. Si n S rinkler Demolition Chan e of Use <br /> DESCRIPTION OF WORK(addition�l space provided on the back): <br /> �3,2��0 s� I.NT��,012. D�iD �C1�i�t2 �N�13�L O� �15T(d,'}Cr �41����b(Z`'1 <br /> $u e I-Dl i�1Cr �`J tt�-I Pv��!'l�-NT', I NCi��t,l�t t�9G 51� 11�1P�,�'j��1'I�.NTti� <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 handlin units Toilet <br /> Forced air s stems Bathtub <br /> Gas i in Lavato wash basin <br /> Water heater Shower <br /> Gas fire lace Kitchen sink&dis osal <br /> Gas ran e Dishwasher <br /> Clothes d er Clothes washer <br /> Ran e hood Water heater <br /> Exhaust fan Sink service/bar/mo /etc. <br /> Heat pump Backflow preventer(inside bld <br /> Unit heater Urinal <br /> Boiler Drinkin Fountain <br /> Refri eration Floor drain <br /> Woodstove Grease tra <br /> Ductin Roof drains <br /> Other Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM Other: <br /> Number of Heads Other: <br /> I hereby certify ihat 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 comp <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 ow of this property to perform the work for which application is made and I comply with the State Contractors Law 1827 RCW and 296200A WAC. \� <br /> �� � �i� � �Z �b ��"� , <br /> Owner/Authorize Agent Signat Fe Date (Revised 4/2015) <br /> 1 <br />