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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 TAXff# PE11 I <br /> J 1� <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> 7'L( <br /> OWNER i ° PhonelE-rrai @� <br /> Address <br /> City/State/Zip C1 <br /> APPLICANT:—owner —Owner's Agent —Contractor _Contractor's Agent —Tenant(must provde a letter of consent from the ovmer to do work in the space) <br /> CONTRACTOR fAID j A 4X State Llc.# L City Bus. Lic.# <br /> Address_ t��. e 7- Phone/Email <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> �1�nte 61_r CA LK <br /> ill r �C5� Phone/E-mail <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK:( <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building Gas Electric Other <br /> Building type: _Single Family _Duplex_Townhouse _Multi-Family _Commercial <br /> T e of ro ect: New Addition Remodel Repair T.I. Sin S rinkler Demolition Chane of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> � s44T �? <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: New_Adds _Alteration_Repair Type of Project: _New_Addn _Alteration`Repair <br /> Show Number(#)of fixtures Show Number(# of fixtures <br /> AIC–air handlin units Toilet <br /> Forced airs stems Bathtub <br /> y Lavatory(wash basin) <br /> Gas piping <br /> Water heater Shower <br /> Itchen sink&disposal <br /> Gas fireplace <br /> Gas range Dishwasher <br /> Clothes dryer Clothes washer <br /> Water heater <br /> Rane hood <br /> Exhaust fan Sink (service/bar/mop/etc.) <br /> Heat pump Backflow preventer <br /> Unit heater Urinal <br /> BoilerDrinking Fountain <br /> Refri eration Floor drain <br /> i 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.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 constriction <br /> That I am authorited 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 /> (Revised 912014) <br /> Ownerl Authorized Agent Signature <br /> Date <br /> 1 <br />