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I . o� ���� <br /> � <br /> i <br /> PERMIT APPLICATIC�N <br /> BUILDING/MECHANICAL/PLUMBINGISIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERiIAIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br /> SITE ADDRESS: � J�,��'"�' PROPERTY TAX# PERMIT# <br /> V�J �„ <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br /> • • <br /> OWNE Phone/E-mail <br /> . <br /> Address City/State/Zi �(, edN'� <br /> APPLICANT:_Owner _Owner's Agent ntractor _Contractor's Agent _Tenant�m�ss Pro�ide a ietter or consaM rrom tne owner to do�odc in me sPace� <br /> CONTRACTOR S State Lic.# � ity Bus.Lic.# <br /> vt0`LS7a'Ks3 <br /> Address� �j hone/Email � <br /> TENANT BUSINESS NAM CONTACT FOR PERMIT/� _ �t e L' __ j� <br /> lA "1�0.!'Z,.' <br /> Phone/E-maii � ��' <br /> BUILDING P RMIT APPLICATION CONTRACT PRICE OF WORK � �' � <br /> . <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building��.--� l Gas Eiectric other <br /> Building type: _Single Family _Duplex Townhouse _Multi-Family _Commercial <br /> T e of ro'ect: New Addition Remodel Re air T.I. Si n S rinkier Demolition Chan e of Use <br /> DESCRIPTION OF WORK(additiona�space provided on the back): � ,�� ��Q,� <br /> ���� . <br /> "'M:ECti��Nl,�L�.PE_. . .� PPLIC TION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New_Addn _Alteration Re Type of Project: _New_Addn _Aiteration_Repair <br /> Show Number # of�xtures Sh --- <br /> A/C—air handlin units Toilet <br /> Forced air s stems Bathtub " <br /> Gas i in s tiasin <br /> Water heater hower <br /> Gas fire lace Kitchen sink 8�dis osal <br /> Gas ran e - - - - <br /> Ctothes d er Ciothes washer <br /> Ran e hood Water heater --- <br /> Exhaust fan Sink servi <br /> Heat um reventer inside bid <br /> Unit heater Urinal <br /> Boiler <br /> —-- <br /> Refri eration Floor drain ' <br /> Woodstove Grease tra - <br /> Ductin <br /> Other edical Gas <br /> SPRINKI.ER/SUPPRESSION SYSTEM =- - <br /> Number of Heads Other: <br /> I hereby certify that 1 have read and exami�ed this application and know the same to be true and carrect.All provisions of laws and ordinances goveming this type of work will 6e compl <br /> with whether spe' her�in or not.The granting of a permR does not presume to give authority to violate or cancel the provision of any other state or Ioca1 law regulating construction <br /> That I m rized e wn of this prop to pertortn the wo�ic for which application is made and I compty with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> � <br /> � �,�� <br /> Owner nzed nt ig t re Date (Revised 4/2015) <br />