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PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/S#'RI:NKLER/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: i S�^�; � r�reRrv Tax# O PERMIT# -�,Z <br /> LEGAL for new construction: Short Platlsubdivision Lot No. (attach copy of long legal description) <br /> OWNER �y��'Q' Phone/E-mail � - ,� <br /> Address '� T ,S' City/State/Zip �� <br /> APPLICANT:/'Owner Owner's Agent _Contractor _Contractor's Agent _Tenant(must provide a iener orconsent from me owner�o do wo�c in u,e space� <br /> CONTRACTOR State Lic.# City Bus. Lic.# <br /> Address - �/ s'��5� S(�/ Phone/Email �.2�-.�3��,f / Q <br /> TENANT BUSINESS NAME GONTACT FOR PERMIT <br /> Phone/E-mail <br /> BUILDIFiC�PE�MIT APPLICATION cONTRACT PRICE OF WORK ODU <br /> Existing Use of Building - HEAT SOURCE: <br /> Proposed Use of Building .SIALC�L.� fQ�M�L_2.�.SlD�A1Ct� Gas Electric Other <br /> Building type: �Single Family _Duplex_Townhouse _Multi-Family _Commercial <br /> Type of project: �New Addition _Remodel Repair_T.L_Sign_Sprinkler Demolition_Change of Use <br /> DESCRIPTIOIv OF WORK a ditional space rov'ded o th back): <br /> S�^`��. �t�'�j ����7� ���/9���/.F�¢�5���'�/��c�+./�i���� <br /> CaNuE27 C�Q� Zo C.tv�a.t4 Spac� �62 s�� � CoNu�.R7 �naw� SPac� zo Ltd�� 545s <br /> Mt��� �.c�nn- Aoprr�oN ?8 S,� �(�w ��K q�N� �olacu- 191 s,F. <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New_Addn _Alteration_Repair Type of Project: _New,�Addn -X`Alteratfon_Repair._.._-- <br /> Show Number(#)of flxtures Show Number(#)of fixtures <br /> A/C-air handiing units - Toilet <br /> Forced air systems Bathtub <br /> Gas piping Lavatory(wash basin) <br /> Water heater Shower <br /> / Gas fireplace Kitchen sink&disposal <br /> Gas range Dishwasher <br /> Ciothes dryer I Clo#hes washer <br /> Range hood � Water heater <br /> Exhaust fan Sink(service/bar/mop/etc.) . <br /> Heat pump � Backflow preventer <br /> Unit heater j Urinal <br /> ; Boiler Drinking Fountain <br /> Refrigeration j 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 /> 1 hereby certify that I have read and examined thfs application and know the same to be true and correct.All provisions of laws a�d ordinances goveming this type of work will be complied <br /> with whether spec�ed herein or not,The granting'of a permit does not presume to give authority to violate or cancel the provision of any other stata or local lawregulating construction <br /> That I am aut ed by the owner of this prop o perfortn the workfor which application fs made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> �- � <br /> �/ � <br /> O er/Authorize nt Signature ate (Revised 3/2013) <br />