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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 ADDRE S: • <br /> PER #Jd ,4 I eitre , lid k off' J 918 o060(a°bd1lin IS o I -bo?� <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER k-t S-I-.1 r C ri m land Phone/E-mail 42 ' 3O-- 05-Sib <br /> Address aJ) U Wind td 1,e_ City/State/Zip Everdi 1 I�C�. qitp,0 <br /> APPLICANT: Owner _Owner's Agent )C Contractorra_1 _Contractor's Agent _Tenant(must provide a letter of consent from the owner to do work in the space) <br /> CONTRACTOR ( e L 1&� �Y�trjj Sa -I-iaY1S State Lic.# gi:L12e-65' t.bE City Bus.Lic.# 4tea 88 <br /> Address I 01 g3 41 T PI k)` Phone/Email -45 3 -5353 <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT //►►//�� L <br /> Y1( Phone/E-mail 44S '4`I 3 ` 6 3S3 <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK 4 500®•co <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 Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> I n 5-A- .11 i n5_ a -Cwr n_ac-e <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: kNew_Addn _Alteration Repair Type of Project: _New_Addn _Alteration_Repair <br /> Show Number(#)of fixtures Show Number(#)of fixtures <br /> NC-air handling units Toilet <br /> Forced air systems Bathtub <br /> Gas piping k 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 authorized •-owner o r pro erform the work for which appli ation is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> Own, /Au j ize• Ag= t Signature D e (Revised 9/2014) <br />