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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 /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS: PROPERTY TAX# PERMIT <br /> /70/ 2 /�/er_�trc, /' /� -3 83s�Kic5«az ('. I . L`, - <br /> LEGAL for new construction: Short Plat/subdivision(/j/c�deetr' / /fY of No/42, (attach copy of long legal description) - ' • .2 <br /> OWNER 7-8`�� / 412-5//Q, .5 Phone/E-mail - 76942 -J//10 <br /> Address 27/22 / J /Z9- City/State/Zip J O�/s7( / 7/1 , q�j <br /> �• !. 'o / 7 <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 spare) <br /> CONTRACTOR firge_.///c /t/ JL& I Lic.# U/18L i 0 j 1ZCOE Bus. Lic. # <br /> Address G,i/GZ A//2°' «- ?6o77 hone/Email 42Gj - 76'c .,.:7--,37c) <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Phone:E-mail - 0 - 0 - A <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK /75 0-0-r) <br /> Existing Use of Building V HEAT SOURCE: <br /> Proposed Use of Buil Mng 5. k. Gas4' Electric Other <br /> Building type: VSin 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 /> �crri.:7h c/ /'ex.x../ S, f7` P c/ C.- . .-r- -/-‘3<_..- <br /> , <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> � i <br /> / <br /> Type of Project: , rvew_Addn _Alteration_Repair Type of Project: 'sew Addn Alteration Repair <br /> Show Number(#)of fixtures Show Number(#)of fixtures <br /> j A/C–air handling units . j Toilet <br /> /-1 Forced air systems Bathtub <br /> / I Gas piping Lavatory(wash basin) <br /> / i Water heater Shower <br /> / I Gas fireplace / Kitchen sink&disposal <br /> / ! Gas range / Dishwasher l <br /> / I Clothes dryer Clothes washer <br /> j Range hood •-____/-----------i-------- tA/at'erTgrer-- <br /> Exhaust fan / j Sink(service/bar/mop/etc.) <br /> I Heat pump / Backflow preventer <br /> Unit heater cX Urinal <br /> Boiler 7" j Drinking Fountain <br /> C f 5 Refrigeration Floor drain <br /> �1�� Woodstove j Grease trap <br /> Ducting 0 Roof drains <br /> I Other j 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 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 slate or local law regulating construction <br /> That I am authorized by the/owners 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 /> /A <br /> _ _4,T �) <br /> li.y' iz•d •gent Signature Date (Revised 6/2012)% <br /> 2 <br />