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r <br /> 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: _tool, nt4 Dri PROPERTY TAX# PE # <br /> - nzv <br /> Pa <br /> LEGAL for new construction: Short Plat/subdivision�tpme � Lot No.TO LM (attach copy of long legal description) <br /> OWNER J ®mey�ji Phone/E-mail g''L j ) 'zg C'-' <br /> Address ‘ O Sit) -y(?Q Q -�`(o t\y,G $4l O'er City/State/Zip C—J r2 a q�' y <br /> '2 <br /> APPLICANT:_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 MINad p((yrnbmt3 pite4i1v')g State Lic.# (( L-AJ ?Ld1F7L`) City Bus.Lic.# <br /> Address I W22 Viand llrtki>Sulk D: sroL 4c('Ir IAA- Phone/Email Tic 34 5100 <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT • <br /> Phone/E-mail 25 54g <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK i S2i <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 space provided on the back): CLa <br /> 0 O SC <br /> �� - 57(4, <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 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 /> Clothes dryer Clothes washer <br /> Range hood Water heater <br /> Exhaust fan Sink(service/bar/mop/etc.) <br /> 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 /> 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 construction <br /> That I am auth 'zed 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 /> s ^ <br /> Owner/Authorized Agent Signature Date (Revised 9/2014) <br />