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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 42.5-257-8857 www.evereltwa.org <br /> SITE ADDRESS: 11 3 /\�vj•�tr 1 I`/ 'PROPERTY TAX q P(V1Ift2 Q(2- <br /> LEGAL for new construction: Short Plat/subdivision t/\J r%' _ _Lot No._ (attach copy of long legal description) <br /> OWNER T`r 9 H S k/ Phone/E-mail O �i 1 3v <br /> Address r 1 .4 ails lam( City/Slate/Lip d' ' V� 4 r D-r) <br /> APPLICANT: Owner Owner's Agent _Contractor __C,niractor's Agent Tenant!must pronto a ixirur of consent from mo owner io eawcrv,n me space) <br /> CONTRACTOR n v\In e State Lic.# City Bus Lic. <br /> Address Phone/Email <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Phone/E-mail <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of Building sSS HEAT SOURCE <br /> Proposed Use of Building^ Gas_ Electric____ Other_,_,__ <br /> Building type: ✓ Single Family _Duplex Tovmhr.use Multi•Family _Commercial <br /> Type of project _ New ,__Addition �/_Remodel Repair-__T I _Sign Sprinkler__Demolition__ Change of Use <br /> DESCRIPTION OF WORK Oda tonal space proved^d on Me back). <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _ New Adds Alteration Repair Type of Project: New,Addn ^Alteration_Repair <br /> Show Number(a)of fixtures Show Number(k)of fixtures <br /> j A/C-are handling units — 1 Toilet <br /> Forced air systems Bathtub <br /> Gas piping 1 Lavatory(wash basin) <br /> Water heater Shower <br /> Gas fireplace _ Kitchen sink&disposal <br /> Gas range Dishwasher <br /> Clothes dryer Clothes washer <br /> j Range hood I Water heater <br /> Exhaust fan I Sink(service/bar/mop/etc) <br /> float pump 1 tiackflow prevenler <br /> Unit healer j Urinal <br /> Boiler I Drinking Fountain <br /> Refrigeration I Floor drain <br /> Woodstove I Grease trap — <br /> Ducting I Roof drains <br /> Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM l Other <br /> Number of Heads I Other <br /> I hereby cenIfy that I have read and examined this nppticA'ian rind know the same to be true and correct Pk provisions of laws and orrirnences governing this type of work vti'I be cemphed <br /> with whether specitred 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 rr.gutaiing 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 Id 27 RCW and 250 200A W'AC. <br /> }/ ,,, c4 <br /> '0r �11� ��1 19j <br /> Owner/Authorized Agent Signature it Dote (Revised 3/2013) <br />