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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 TAX# PERM T <br /> 261 OA ICES ,GIVE`. 00¢391 f f�62S00 �I I I -®4I <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER A L[.EA) E., pc..12,[e Phone/E-mail 4-25-923-3091 a_peirte.e-rro►,rher.co.v <br /> Address (StaAle) City/State/Zip EE -r?- WA 9820 t <br /> APPLICANT: )C 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 *Amer State Lic.# City Bus. Lic.# <br /> Address Phone/Email <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Phone/E-mail <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK`S 28 00. C/1.) 4v <br /> Existing Use of Building 25 RE5. HEAT SOURCE: <br /> Proposed Use of Building r• Gas_ Electric X Other <br /> Building type: k Single Family _Duplex_Townhouse _Multi-Family Commercial <br /> Type of project: _New Addition Remodel X Repair-T.I. Sign_Sprinkler Demolition Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> REPLRC6/QErtgIR EXisTIN6 d—Mtsunta SKI,eTTING H/L//:.I arp 4-PE'SJ6 M• <br /> RMPA/R/2ept4ce C.EDAI.T1.0NGt-RoWnJ , (Ncc. 1x6 SKIP lfE497Z1A0t=AS NOVO) &.s/4.rCCK*NR <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: New_Addn _Alteration!Repair Type of Project: _New_Addn _Alteration_Repair <br /> Show Number(#)of fixtures Show Number(#)of fixtures <br /> " A/C-air handling units i Toilet <br /> Forced air systems j Bathtub <br /> Gas piping 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 Water heater <br /> Exhaust fan • i Sink(service/bar/mop/etc.) <br /> Heat pump Backflow preventer <br /> Unit heater I Urinal <br /> Boiler Drinking Fountain <br /> I Refrigeration Floor drain • <br /> Woodstove Grease trap <br /> Ducting Roof drains <br /> Other Medical Gas <br /> SPRINKLER/ SUPPRESSION SYSTEM Other: <br /> INumber of Heads I 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 compile. <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 construction <br /> That I am a riz-.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. fa� <br /> Z <br /> Owner ,ut orized Agent Signature Date (Revised 3/2013) <br />