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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 vwrw.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS:0)j _ �]/� pi e PROPERTY TAX# PERMIT# <br /> (� /rel/ J <br /> 114-000r-002-- <br /> LEGAL for new construction: Short Plat/subdivision Lot No.3t (attach copy of long legal description) <br /> OWNER. S�a pfi �' 'r � Phone/E-mail 1/25-- ?�3 --2f0 " <br /> Address 12 0 .st vete oil �. • W City/State/Zip i"• <br /> r r a 020' <br /> APPLICANT:_Owner Owner's Agent Contractor X Contractor's Agent _Tenant(must provide a letter of consent from the owner to do work In the space) <br /> CONTRACTOR vaCr / �� IL&I LIc.# pnpL,� �. COE Bus.Lic.# .�{f�� <br /> Address I iti.2 6)c,jC �" a S I Oh v phone/Email 4 31/t'a 00 , <br /> TENANT BUSINESS NAME t <br /> CONTACT FOR PERMIT ., 41-c-a d 9- ZI 4 5- <br /> lT rt ei /C <br /> Phone/E-mail r,'. _.t. a IC a/U Al a//Z.- II t I. <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK ar <br /> C <br /> Existing Use of Building CCM 1 <br /> 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 /> DES CRI PTI ON OF WORK(additional space provided on the back): <br /> • <br /> f(..., <br /> S tif /r J-(` r, <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 /> NC-air handling units Toilet <br /> Forced air systems Bathtub <br /> Gas piping Lavatory(wash basin) <br /> J Water heater Shower <br /> Gas fireplace Kitchen sink a disposal <br /> Gas range <br /> Dishwasher <br /> Gibfhes dryer J <br /> :Nix! J Clothes washer <br /> Rangehaust fan Water heater <br /> Sink(service/liar/mop/etc.): <br /> Heat pump Backflow preventer <br /> Unit heater Urinal <br /> Boiler <br /> Refrigeration Drinking Fountain <br /> IrVogdstoYe J Floor drain <br /> Grease trap: <br /> Ducting Roof drams <br /> I Other Medical'Gas <br /> SPRINKLER/SUPPRESSION SYSTEM Other: <br /> a1:91% Number of Heads ( Other: <br /> • <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 /> iji . lik)ii‘O . .1'"'"\ <br /> Owne uthorized A: Signature Date <br /> (Revised 6/2012) (\f_) <br />