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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# PERMI=T# <br /> 7th /67o0v� 66 5,,,ek„ C- z ¢C3 hj l�-t f _ 24 <br /> LEGAL for new construction: Short Plat/subdivision / Lot No. (attach copy of long legal description)^ <br /> OWNER d 9 � revo/t t/ L.15viii�l rl. R/�itnC,/Phone/E-mail 42�- sU� q !d <br /> Address 3?5 2, �I j,// �v S�� /O City/State/Zip c v-61 q,9 Z d l <br /> APPLICANT: Owner _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 Sed-dA 1.4 1,c, (p4,61fuch& '44.C._., State Lic.# t,..,j(i,'S�, ic,9 .p' City Bus. Lic.# <br /> Address 1-74 63 <4'0 DL.. AP-6 Phone/Email 1114,5-87o-SO 3 2_ <br /> TENANT(BUSINESS NAME i_ CONTACT FOR PERMIT <br /> Pt 6-6( rrfAarl�e..4 <br /> Phone/E-mail <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK 41/ . 3J .ao <br /> Existing Use of Building t.4./4-4. r 11 4047HEAT SOURCE: <br /> Proposed Use of Building Gas i Electric_ Other <br /> Building type: _Single Family _Duplex Townhouse _Multi-Family 4Commercial <br /> Type of project: _New _Addition _Remodel _Repair_T.I. t Sign_Sprinkler Demolition Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): Gi/a/'` . , or <br /> 4� 1-r/d,;.,7Jy jam, a„�� e,-F- <br /> ,G Sc- 5 �..e eie.14- a p�,,�,� (J �blO CtrG� 4-o GI le� <br /> ac!, 4a ...90.rG.1icscc.Sc.- . r ,iJ IVlect y <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 /> ( NC-air handling units Toilet <br /> I Forced air systems Bathtub <br /> Gas piping Lavatory(wash basin) <br /> Water heater Shower <br /> Gas fireplace I Kitchen sink&disposal <br /> Gas range j Dishwasher <br /> Clothes dryer j Clothes washer <br /> Range hood Water heater . <br /> Exhaust fan Sink(service/bar/mop/etc.) <br /> Heat pump Backflow preventer <br /> - - -I Unit heater i Urinal <br /> I Boiler ( Drinking Fountain <br /> Refrigeration Floor drain - <br /> • <br /> Woodstove i Grease trap <br /> Ducting Roof drains <br /> Other Medical Gas <br /> SPRINKLER/SUPPRESSION SYSTEM 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 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 /> / <br /> Owner/Authorized Agent Signature Date (Revised 3/2013) <br />