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• � <br /> PERMiI' APPLlCATI�N <br /> E.�IJILDIfV(a/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 /> �.�r� <br /> SITE ADDRESS: PROPERTY TAX q PERMIT# <br /> "� CJ�K�-S . .'� C.)G� � �-i:� ��cJc.r �,C�� �?i <br /> C c F �� �j -��, <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br /> OWNER � � ��• � �,, Phone/E-mail j� - ;.�i� - ` y(1.C� <br /> Address � � q;��y�_'L �J'L City/State/Zip �yf.�z��; Z„ �'c� • �; <br /> APPLICANT:_Owner _Owner's Agent �G Contractor _Contractor�S A92flf _T2f12f11(must provide a Ietter of consent from the owner to do work in the space) <br /> CONTRACTOR � � ' y � d � ,,,��� JI.Lt� State Lic.# City Bus. Lic. # <br /> Address ��; � „� -��3 j f���� �-�"�� �„_a �0 4��:Z.�i Phone/Email <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> ��� '��,�t,t,z 7' �tZ �--��� •��Z�{L. <br /> Phone/E-mail '1�bD K_ tT t_��z`( �'. �i•a t(,. .i.t��� <br /> BUILDIWG PERMIT APPLICATION CONTRACT PRICE OF WORK ��4 <br /> Existing Use of Building,S �}:���.-'r.- H�.�..,_�-., �-=z 5 HEAT SOURCE: <br /> Proposed Use of Building 1-iv •...�i.� ����'r� ( ��l�l Gas_ Electric r 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 /> DESCRiP�'!ON OF WORK(additional space provided on the back): <br /> �bn��-�`�� ex;��� 9��� ����t�l��� -�-r► � ao�� �c. �w��� s�e�, <br /> a 1hd ��a�R- 7� Grz�ta7� S�'2 W17µ1 ��6S�i�G 571���1�2� <br /> MECHANICAL PERMIT APPLICATION PLUMBING PER�iVi1T' 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 /> i Gas piping j Lavatory(wash basin) <br /> Water heater '�, Shower <br /> ' Gas fireplace � i Kitchen sink&disposal <br /> ; Gas range Dishwasher <br /> Clothes dryer Clothes washer <br /> Range hood Water heater <br /> j Exhaust fan ; Sink (service/bar/mop/etc.) <br /> j Heat pump i Backflow preventer <br /> ; Unit heater Urinal <br /> Boiler i Drinking Fountain <br /> Refrigeration j Floor drain <br /> Woodstove Grease trap <br /> Ducting Roof drains <br /> ��.�''`���_A#{�r"c;.s��i-- �z.s ,�-z.��ti,i�.- ; Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM � ' Other: i/`y'1���� �;c'(��;�' <br /> k Number of Heads i 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 permil 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 property to perform the work for which application is made and I compty with the State Contractors Law 1827 RCW and 296.200A WAC. r <br /> i � -��- - - ��` . <br /> � � y � �� � <br /> � r/Auth'rized Agent Signature Date (Revised 3/2013) <br />