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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: V Cl4i_ ,,i PROPERTY TAX# I PgRMIT# <br /> 73 z.& RA:Ai/6 e- DR- 9/zL; 13o 3-010 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER /11, Phone/E-mail II)5 - g4, 3 —// /j/ <br /> Address 3 ; L Z' i3 ie.:,a j)1,..3,4 7 City/State/Zip E v&/- 7 rr /u/,.f 5 g L C <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 /✓E DAi S - 727k5 L&I Lic.# gi Al S o foto COE Bus. Lic.# <br /> Address L/G P( /3%�`'- A2Z. 5 /7.1 ,L C C C cca-‘- Phone/Email AL2 5 - S 5,5 Y//7 5 <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> L. j L 7 <br /> j) / .I /'A.c T/y>Eti i S Phone/E-mail 4J S— S 5 3 g f T S <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK t D C7 <br /> Existing Use of Building 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 /> DESCRIPTION OF WORK(additional space provided on the back): <br /> I <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 /> 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 / 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 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 /> /t.! / e40.2% <br /> Owner/A or' ed A•: t Signature Date (Revised 6/2012) <br />