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fiNS , '500 1 Codes <br /> • <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 /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM 1 <br /> SITE ADDRESS: L <br /> PROPERTY TAX# .:-/0809 s a 30 P MIT"�� <br /> • �,� ►_ S• , 3_ • •�e _ :c)4�' oo o .oO 4 (0 , 43' Z <br /> LEGAL for new construction: Short Plat/subdivision Lot No. . (attach copy of long legal description) <br /> OWNER WQSN-z_ �C �5-\ � 5 ��} sp Phone/E-mail , 1cQ,Lp6-42_ESTMeS()(3v__‘\00)1.Co'vy\, <br /> Address '1-7 0 \ V.\ R V QSO t) S'�-� • City/State/Zip Q (p r W{� amp 1 <br /> APPLICANT: Owner Owner's Agent Contractor _C Contractor's Agent Tenant(must provide a letter of consent from theemowner to do work in the spac ) <br /> CONTRACTOR Am*Q1ctAN �\Lf• � Q SERO ,L&I Lic.#ROER\�("©`c�1S�T G;Ut tiu�s'L .#HQ$5 r <br /> r <br /> er Ro'e :�1t_ ,D-31•ZO\co exp <br /> Ad ess 2� �71 5P.1 fit' . 4(f t Luc/ 9R2q f Phone/Email (,0 _O\QQ n <br /> TENANT BUSINESS NAME CONTACT FOR PERMITf‘MEQ\Ct{c1/41.-) kt-E tkb VN Z. <br /> ? s�R v�c�®G\rci,,l coves <br /> Phone/E-mail <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK /O. O 0 <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building11108\LQ .--EL Gas Electric Other <br /> kAaV <br /> Building type: '`Single Family Duplex Townhouse Multi-Family Commercial <br /> Type of project: X New Addition _Remodel Repair T.I. Sign Sprinkler Demolition Change of Use <br /> DESCRIPTION OF WORK(additional space pro • <br /> ided on the backL. <br /> pc‘r6% 5 \\o� C�0 g L� 1 �fL �s tNSVe �, � ) tr Vic\Wk <br /> o(N S- ( Vo.c0.•c4 lo't— <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 I SUPPRESSION SYSTEM -Other: �( �j <br /> Number of Heads / Other: 5p�(,{J (k .e <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 complied <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 /> ,c2 <br /> Owner AuthoorizeeddAgelat Signature Date (Revised 6/2012) <br /> ( <br />