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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# P RMIT# <br /> ?tc/ 6<;/4-14( oo5/' 4/o/t7© '0©O jU) i4i 5-00 <br /> LEGAL for new construction:( / Short Plat/subdivision Lot No. (attach copy of long legalledescription) <br /> OWNER PSI )�i (�dap ��//�,b/6 •rttn Ni / /„+ Phone/E-mail ✓2asS,.-�r(lr�o of c� / 7',,i# /, C,i'7 <br /> Address .41‘,./..q /4/i Tvl, Sf4' S City/State/Zip !�! /7 Com/-,ate-/c Y ,l <br /> APPLICANT: V 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 , c+S'S ) fit/®�r /� (WM"State Lic.# City Bus. Lic.# <br /> Address L/$10�` /3L/ `f/r /�L .5--re Phone/Email fcba f <br /> TENANT BUSINESS NAME CONTACT FOR PERM'? 'fps`���4 n4/4/Arev-�, "� -• �— amass �/ate <br /> Phone/E-mail 2ors`. /° L'D' <br /> BUILDING PERMIT APPLICATION -CONTRACT PRICE OF WORK /2, '°0 <br /> Existing Use of Building P-' chit;nk4,I HEAT SOURCE: <br /> Proposed Use of Building CAM is-1011 14-•••0 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): <br /> SE P,. CONI/2tes:0 r1 aT S/CI� O (. c QJ <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 compl <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 authorized 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 /> " (-6L(( <br /> Owner/Authorized Agent Signature Date I Z- S r Revised 14) j2i <br />