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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# # <br /> 9,33 Pf 1 d00100S-0o I P ( 7 O -of-6 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER k-e ma `! ( j (� Phone/E-mail 60(,) q c gyp' o- <br /> Address r7-3I a' �( $ 1 City/State/Zip 94 )4-( �/� �'�39O, <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 <br /> lb <br /> kin° (4..ea_4,;h )/ int t State Lic.# 4 L(771',(')E-{ 4 City Bus.Lic.# C�� <br /> Address 990 J t 1 ' w, is Vd1L l-1 <br /> _inn.io 1 e Phone/Email L{'�j 51 g <br /> TENANT BUSINESS NAME v' CO TACT FO PERMIT <br /> 9:7C—5 <br /> Phone/E1 CifaC) <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK r <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building Gas)( Electric_ Other <br /> Building type: X Single Family _Duplex_Townhouse _Multi-Family _Commercial <br /> Type of project: _New _Addition _Remodel )C Repair—T.I._Sign_Sprinkler Demolition Change of Use <br /> DESCRIPTION OF WORK(additi nal space provided on the back);, <br /> f [CLC a/°) 11C(-)O imeA_ tite tiAbc- <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: New Addn _Alteration XRepair 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 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 thi applica'•n and know the same to be true and correct.All provisions of laws and ordinances governing this type of work wtl be comp) <br /> with w ethers �«ed he or n The• ti of a• d does not presume to give authority to violate or cancel the provision of any other state or local law regulating construction <br /> 4liat I m au •ed by t': •wn to•= rm the work for wh' application is made and I complywith the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> • 79e9 <br /> er Au or d Agent g�rraa re Date (Revised 9/2014) <br />