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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:/ /id (_ ) I n yew veire e PROPERTY TAX# P,eRMIl#t I f , <br /> 14- lP <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) � <br /> OWNER (11 <br /> tG�a r 0si 1( Phone/E-mail <br /> Address 6)).)1 � yJ� S� k `//76((, to 7t2c City/State/Zip <br /> APPLICANT: wner _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 C.CA7 t'r co y' State Lic.# City Bus. Lic.# <br /> Address Phone/Email <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Phone/E-mail <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of Building i t'1 Le ct 1k?r HEAT SOURCE: <br /> Proposed Use of Building Gas Electric 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 /> I V`v." d 5�/ �1 ti� UA fv eV' r�(cX: %t r1- K�o� PC C�ov6S e <br /> Mc'^ 3 <br /> o-Vi 3 cs.,,r e,, 3e <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 handling units Toilet <br /> Forced air systems Bathtub <br /> Gas piping j Lavatory (wash basin) <br /> Water heater ! Shower <br /> 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 I Backflow preventer <br /> Unit heater Urinal <br /> Boiler i Drinking Fountain <br /> Refrigeration ( Floor drain <br /> Woodstove Grease trap <br /> Ducting j Roof drains <br /> Other Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM j 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 authorized by the owner of this•ro.e. o perform the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> — ®z /, r/ <br /> Owner/Authorized Agent Signature - Date (Revised 3/2013) <br />