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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 tt P R NIT <br /> 0005 Pre'k.- li it- A ( 9--O u u <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER Id. 40, 1. .RI UI. Phone/E-mall 4S--44?1—(6I / O10Ls•7"? kabnal .an <br /> Address , •Q s ;r. • !. .-. It a-J. , , Clty/State/Zip , ki LOA q$c.c l <br /> APPLICANT:_Owner Owner's Agent V 1 Contractor _Contractor's Agent _Tenant(moat provide a tetter of consent Tram the owner to do work in the spore) <br /> CONTRACTOR ()aynVg6 fQei(Yh L&I Lic.# • e L ! •&. _CY11 COE Bus. Lic.# cal5(0 <br /> Address <br /> � a-il A„ SE i Pr Qac.: : .1: .r Phone/Emai, 4 ;9635." 01 II <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT Li-- <br /> ),(XD <br /> J—)1J(o-155(p--' &. 1 CA-Ct f q@ CYic ams54o+n tsroc cam, <br /> Phone/E•mall U Cc�r�' ' <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK 0 V <br /> • <br /> Existing Use of Building ` Q&J-(12— HEAT SOURCE: <br /> Proposed Use of Building _ Gen ^ Electric Other_-,-,,, <br /> Building type: VSingle Family _Duplex Townhouse _Multi-Family _Commercial <br /> Type of project: New _AdditionRemodel Repair T.I. Sign Sprinkler Demolition.....Chan�e of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> i (ace.. Cava -s►r 03/++1t om pas- sig . <br /> MECHANICAL, PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: New,_ ddn Alteration Repair Type of Project: _New,_,_Addn Alteration_Repair <br /> Show Number( of fixtures Show Number(4)of fixtureg <br /> A/C—air handling units Toilet <br /> Forced air systems _ Bathtub <br /> Gas piping Lavatort(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 Drinkin Fountain <br /> �_ Refrigeration - _ Floor drain <br /> — <br /> Woodstove Grease trap <br /> Ducting _ Roof drains <br /> Other Medical Gas <br /> SPRINKLER/ SUPPRESSION SYSTEM Other <br /> I Number of Heads Other: <br /> I hereby certify that 1 have reed and examined this application and know the same to be true and correct.All provisions of laws and ordinances governing this typo of work will be compiled <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 om 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 ROW and 290.200A WAC. <br /> �I/ ► 1� ittl.l�i y O <br /> owner/A"or z,d Agent Signature Date (Revised 6/2012) <br />