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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� J P�R�MIT�r�� I ��� <br /> I K�.� 1 v <br /> LEGAL for new construction: Short PlaUsubdivision����d�t�- 2k Lot No. (attach copy of long legal description) <br /> OWNER�Z��z �.{���-t.� �.��/VL�� Phone/E-mail �4zS) Qt5'3 Z�j�'� <br /> !z O �!vL�,�T )v�w �.v��-{ <br /> Address ���T ti �po City/State/Zip t�rzQ.�T �A. ��ZOh <br /> APPLICANT: _Owner _OwnePs Agent _Contractor _Contractor�5 AgBnt _TBnant(must provide a letter oi consent from the owner to do wak in the space) <br /> CONTRACTORS��CTI_--� T� ��Mr�1 State Lic.#$�,�[rPc-�O� <br /> �$J Cit Bus. Lic.i(cp3-L.�Ob ���G <br /> Address Sll���. Phone/Email S r��M� . <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> �OtW V?�swFt�2c� <br /> Phone/E-mail ��Z-S � �ri U"�.O UZ <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 /> Ty e of ro'ect: New Addition Remodel Repair_T.I. _Sign_Sprinkler_Demolition Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): � <br /> i����� CZ--�� ►�z cf.� i-� �'L�:� --2Ze�3- `�e�-� <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: �New_Addn _Alteration_Repair Type of Project: �ew_Addn _Alteration_Repair <br /> Show Number(#)of fixtures Show Number(#)of fixtures <br /> � A/C-air handling units Toilet <br /> \ I Forced air systems � � Bathtub <br /> Gas piping � Lavatory(wash basin) <br /> � � Water heater � Shower <br /> 1 Gas fireplace � I Kitchen sink&disposal <br /> }E � Gas range � Dishwasher <br /> � Clothes dryer ( Clothes washer <br /> 1 Range hood ' ��atPr n�, <br /> � j Exhaust fan Sink(service/bar/mop/etc.) <br /> �-- i Heat pump — � Backflow preventer <br /> � I Unit heater Urinal <br /> I, Boiler — i Drinking Fountain <br /> � Refrigeration ; Floor drain <br /> � Woodstove -- Grease trap <br /> � Ducting ; Roof drains �.s,�,,i..►$P�;��.� <br /> � Other -- Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM � Other: <br /> '—'— Number of Heads j 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 complied <br /> with whether specified here�1/p or n�t.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 author^�ted y th 6w�qoithis 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 /> ,r 0 <br /> � � <br /> t�i�' �—i�- 1�E <br /> Owner/A hanzed Agent Signature Date (Revised 3/2013) <br />