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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: 0 `q"4 DR- <br /> S PROPERTY TAX# err l vcl^ 603 <br /> 6..t !t <br /> LEGAL for new construction: Short Plat/subdivision �Y f►� ' f► S Lot No.0(9'3 (attach copy of long legal description) W <br /> OWNERS ',1'C-%L_. Homes Phone/E-mail J26 9.55 ZgQO <br /> Address 12� ih} \je oyJ I 410( City/State/Zip G-t/ (2.. -4- taJyy2.0 <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 d pI /ir biJ'3 N1147'106) State Lic.# t- PLVILS City Bus.Lic.# <br /> Address + X22 (Gtt f3tirX ,Sid/ iio fr o ,i f!(„l11 Phone/Email S. 3g ? 5i 00 <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Phone/E-mail ,�35 5 1 OO <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK p 6sis, <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 Chane of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): 0(p —04' t <br /> Md 3L /' <br /> 611 ---4fif 1(, <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 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 /> Owne uthorized Agent Signature Date (Revised 9/2014) <br /> ��2 <br />