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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: `Ito nn `�� �nD PROPERTY TAX#p�� mr,140 ...0toLEGAL for new construction: Short Plat/subdivision PIVI )t (t Lot No.C-A4 (attach copy of long legal description) <br /> AOdWdrNesEsR 1S2(407 i�(�Q 90 e jC, <br /> .( Homes Phone/E-mail 1 25 (155 z goo <br /> \)e .e <br /> - ova OD City/State/Zip f✓)Q(' f-+ q q20 <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 /> CONTRACTORo aYd plubj/1 ipJ'JcI Y'•)(4 State .VJ Lic.# y t ) gpL9i7t.3 City Bus.Lic.# <br /> Address 1822. Aj ckAchol 7,51.i i k ID; silo Porn I shf IA/74 Phone/Email /11, 3g 5100 <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Phone/E-mail 1-1126 — 5 IOC <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK W..51-3" <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. Sjgn Sprinkler Demolition Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> 57arieLLjsi 6-11 <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 /> a2 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 comps <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 lam aut •rized 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 /> 12-02-ll 4 <br /> Owner/Authorized Agent Si ature Date (Revised 9/2014) <br />