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Z Z lv � <br /> PERMIT APPLICa4TIC�N <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITI�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.or <br /> r� � D� <br /> SITE ADDRESS: PROPERTY TAX# PEf�AI # � , �; �i) , <br /> i li <br /> LEGAL for new construction: Short PlaUsubdivision Lot No.__ (attach copy of long legal description) <br /> OWNER �j�Zt�1 i �4 i�l '��C_. �,M�_ Phone/F_-mail L�Zj� � � 3 •-�--"v�'�� <br /> Address "Z� `,,_j v1r'/1, .l ��_t..i� �,;�,L1 City/State/Zip �v�i'�,i�-'C Ll..�- ��=3�-��' <br /> APPLICANT:_Owner _Owner's Agent _Contractor _Contractor�S A90fil _T8f18f11(must provide a letler of consent from the owner to do work in the space) <br /> CONTRACTOR `�j�..��T� �,�4-` ' �(_ l ' .�rS State Lic.#`.�za�j�'at�c:�S-��= City Bus. Lic. # � <br /> Address iZ�,; S :.r..t �Z.vr�2.-�,Z�� 1/�/V�-�L... �,(.'.,� �hone/Email �ZS��5 3 " Z�'�C.`�`v <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT �-� �� ����'�,Z.�.( <br /> Phone/E-mail ��'Z� �j—C.: "�1..."`�� - <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 /> Type of project: ' New Addition Remodel Repair_T.I._Sign_Sprinkler_Demolition_Change of Use <br /> DESCRIPTION OF WORK(additional s�c�pro�ed on the back): <br /> ��s) � �z7� � <br /> � �03 <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 /> i Forced air systems "� ! Bathtub <br /> j Gas piping j Lavatory (wash basin) , <br /> � ' Water heater Z � Shower <br /> , <br /> j Gas fireplace i Kitchen sink&disposal <br /> j Gas range i i Dishwasher <br /> Clothes dryer � Clothes washer <br /> Range hood � Water heater <br /> � Exhaust fan — ; Sink(service/bar/mop/etc.) <br /> j Heat pump ; Backflow preventer <br /> — ; Unit heater Urinal <br /> --- Boiler Drinking Fountain <br /> ; Refrigeration Floor drain <br /> -- ; Woodstove Grease trap <br /> _ Ducting — Roof drains <br /> j Other — ; Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM i Other: <br /> -- � Number of Heads Other: <br /> I hereoy 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 /> wiih 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 thorized b the o ner of this property to pertorm the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> /-Z-/q �' Z <br /> Own Authorized Agent Signature Date (Revised 3/2013) <br />