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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 <br /> D DESS: PROPERTY TAX# P RMIT# <br /> -5"C C i 7-906-5/oO3,�06 EW 1505-00'L <br /> LEGAL for new construction: Short PPllat/subdivisionLot No.� (attach copy of long legal description) <br /> OWNER e. Tom-- Phone/E-mail 41-5----210-7773 f��� <br /> Address �` 6 City/State/Zip ie j A41,–. /Axe..0_L I e COP", <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 State Lic.# City Bus.Lic.# <br /> Address Phone/Email <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> 5Vt61 e t" kry ( ZSR'(izy1�®(`i 7u3 <br /> Phone/E-mail YOt4 —l.�l"�epr i I <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK t 0,017 ° <br /> Existing Use of Building i " 'N1 /�p� H T SOURCE: <br /> Proposed Use of Building \-c'L7 0.11 �i'/^ GaElectric_ Other_ <br /> Building type: 8ingle Family _Duplex_Townhouse _Multi-Family Commercial <br /> Type of project: New , --"Addition •4's'flemodel Repair_T.I.—Sign Sprinkler,Demolition_Change of Use <br /> DESCRIPTION OF WORK(additional spacg provided on the back): ppI ,, z 1C )fit i <br /> Prt-WA --6 i - -. <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: , New Addn _Alteration_Repair Type of Project: 1New Addn _Alteration_Repair <br /> Show Number(#)of fixtures Show Number(#)of fixtures <br /> NC–air handling units `I • Toilet <br /> Forced air systems I Bathtub <br /> Gas piping I 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 p Water heater <br /> Exhaust fan ! Sink(service/bar/mop/etc.) <br /> Heat pump Backflow preventer <br /> Unit heater Urinal <br /> Boiler Drinking Fountain <br /> Refrigeration Floor drain <br /> Woodstove 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 comp) <br /> with whether specified herein or not.T e grant';•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 - =uthorize.r• the owner o i,• 'ny 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 /> Owner/A • • .' t Signa ure Date (Revised 9/2014 <br />