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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 /> 6bc1 3 L_� ASE -1 <br /> SITE ADf.�2E S: � T ��ROPERTY TAX# ATTTLi <br /> -Lo <br /> LEGAL for new construction: Short Platisubdivision Lot No. (attach copy of long legal description) <br /> OWNER Bbl �7 Phone/E-mail <br /> Address City/State/Zip L,C , w� �Z�{ —z'2,07 <br /> APPLICANT:--k 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.# j1<4106 22 ET City Bus. Lic.#Cy4+3 <br /> Address Phone/Email <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> DSA` M -q o-�5-2 3'9'v t'1� <br /> Phone/E-mail MI 15L 2— �6154 136 CZ M <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK `7 i' CLC- <br /> Existing Use of Building M FG HEAT SOURCE: <br /> Proposed Use of Building M F& Gas Electric_ Other_ <br /> Building type: _Single Family _Duplex_Townhouse —Multi-Family Commercial <br /> Type of project: _New _Addition _X_Remodel _Repair_T.1._Sign_Sprinkler Demolition _Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New_Addn _Alteration_Repair Type of Project: _New_Adds _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 Lavatory(wash basin) <br /> I 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 /> Exhaust fan Sink(service/bar/mop/etc.) <br /> Heat pump Backflow preventer <br /> Unit heater Urinal <br /> Boiler j 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 complied <br /> with whether specified herein or not.The granting of a permit does not presume togive 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 /> Owner/Authorize g nt ignatur, Date (Revised 3/2013) <br />