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'ERMIT APPLICATIC : . <br /> BUILDINGIMECHANICAL/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# P RMIT# <br /> / ��C: � - - D - �?�� <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER ��Z s /-`� a✓ 'l Phone/E-mail ���) �.� � �. 7,�,5� <br /> Address ���� ���1 � .���`✓ City/State/Zip L�� � .'"� �„'� �"�'�� <br /> APPLICANT:_Owner _Owner's Agent �Contractor _Contractor�5 A92flY _T@f78flt(must provide a letler of consenl from the owner to do work in the space) <br /> CONTRACTOR � ` 1Z(��3V f State Lic.#%�'�, �_�, ��'" '�' -�r City Bus. Lic.#���17 ' <br /> Address �( � , � ��- / L Phone/Email� ��5� �S 7— _�jI <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT ���-J �G�,_��z�- <br /> ,�:'�t�:; <br /> Pho�m il �L✓i.. " i �/Y/(1,,�[;(.,,.L�Ca6�yf <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK � ��,`--�''_ <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building Gas_ Electric Other <br /> Building type: X^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 /> ���1'� �� �111,(�1'��i� ��1,�11�" �V I'Y�-9 <br /> MECL�ANIC�►L PERIVII� APPLIC�'►7'EON PLI�M�l�dfs PERM1� �4PPd.lCATIOtd <br /> Type of Project: _New_Addn _Alteration_Repair Type of Project: _New_Addn _Alteration_Repair <br /> Show NumBer(#)of fixfures Show Number(#)of fixtures <br /> � A/C—air handling units ; Toilet <br /> Forced air systems � Bathtub <br /> Gas piping � Lavatory(wash basin) <br /> � Water heater � Shower <br /> j Gas fireplace � Kitchen sink&disposal <br /> � Gas range 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 /> � Unit heater I Urinal <br /> � Boiler i Drinking Fountain <br /> � Refrigeration � Floor drain <br /> Woodstove � Grease trap <br /> � Ducting � Roof drains <br /> � Other j Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM j Other: <br /> INumber 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 o�not.The granling of a permit does not presume lo give authority to violate or cancel the provision of any other state or local law regulating construction <br /> That I am aulhorized 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 296200A WAC. <br /> � 1 ,� � ' <br /> �-� �- -i � <br /> Owner/Auth rized Agent Signature Date (Revised 3/2013) <br />