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PERMIT APPLICATION <br /> 1 <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES ' <br /> 1 3200 Cedar St., Everett,WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br /> I <br /> 1 SITE ADDRESS;_, �}�,� �, • PROPERTY TAX# perri,#^ —OW <br /> LEGAL for new construction: Short Plat/subdivision`J ,h atC al «f//on) <br /> ���\ Lot No.�wt(attach copy of long legal description) <br /> OWNER V 0, tom tc2,\60,\t. Phone/E-mail 'moi S. Lk. (z .' -{ LA Li <br /> Address 1 V/k '' bt1 t \( \ . v-eV.C, City/ tate/Zip cLzAt.._(`-e ' V` a.RAD C_ <br /> APPLICANT:_Owner Owner's Agent X Contractor _Contractor's <br /> Agent Tenant(must provide a letter of consent from the owner to do work in the spie— <br /> 1 <br /> CONTRACTOR <br /> ' �,e1 �c�j�� � A`Ce 1 ,�i' tate Lic.# �jL��6 ' ` (ecity Bus. Lia#063135 <br /> Address1-\\4-. .Q -r`` •`")--- kr-\,k_. \ Y \ °L) <br /> 3 `�tscb` - b' - l <br /> sePhone/Email U U <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Phone/E-mail <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK ''- c->1-O -U� <br /> Existing Use of Building HEAT SOURCE: ,iExisting <br /> Proposed Use of Building <br /> Gas^ ElectricOther_ <br /> 1 Building types( 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): <br /> 1 <br /> 1 MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> 1 Type Project:Project: _New <br /> _Addn Alteration_Repair Type of Project: _New_Addn _Alteration_Repair <br /> Show Number(#)of fixtures Show Number(#)of fixtures <br /> 1 NC-air handling units Toilet <br /> I Forced air systems Bathtub <br /> Gas piping Lavatory(wash basin) <br /> Water heater Shower <br /> I Gas fireplace Kitchen sink&disposal i� <br /> 1 Gas range Dishwasher <br /> Clothes dryer Clothes washer <br /> 1 Range hood Water heater <br /> Exhaust fan Sink service/bar/mo./etc. <br /> Heat pump ti Backflow preventer <br /> Unit heater Urinal <br /> Boiler Drinking Fountain <br /> Refrigeration Floor drain 1 <br /> Woodstove Grease trap <br /> Ducting Roof drains <br /> Other Medical Gas <br /> SPRINKLER/SUPPRESSION SYSTEM Other: <br /> Number of Heads Other: <br /> 1 I hereby certify hat 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 corn• <br /> with whether pecifiied herein or not.The granting of a•ermit does not presume to give authority to violate or cancel the provision of any other state or local law regulating construct 1 <br /> T I a a •' ed• •,•.--y to perform the work for which applk.atior+is made Tic!. ccmply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> Owner/ thori d Agen ature Date (Revised 9/2014) <br />