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u <br /> 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 "RM # <br /> le 7p 2 2 OR.. .c- o0e,s 270'0006U1G0 VinlbQ r'ONO <br /> LEGAL for new construction: Short ` /✓it Plat/subdivision Lot No. <br /> (attach copy of long legal description) L <br /> OWNER Kyi s k T, 1ti1 J 11 ill lt s 4Phone/E-mail `/ZS--— S g,�— g37 pi 4 Li,.,t//47'",(e.,10/.CO <br /> Address /0/0, 2 7 Pk x i4 City/State/Zip c�vei/e iv 4 , Y2 0(") <br /> iJ <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 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 HEAT SOURCE: <br /> Proposed Use of Building Gas X Electric_ Other_ <br /> Building type: )1 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 /> ge eki ce exisr,'v J i1eU,�n l s vi�t'°_ 4jo r <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Projeot: _New_Addn _Alteration_Repair Type of Projeot: 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 II 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 aut orized by the owner o his 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 /> Owner/Auth ized Agent Sig -cure . Date (Revised 9/2014) <br />