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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 ?t D`` Zo C`C i F u e_- AVC PROPERTY TAX# PVo 1MIT�'�'©I(,, <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of tong legal description) `� <br /> OWNER 'V'L\ 6 ( \\AOC Phone/E-mail L4 )5- {11.6" LAO ace, j <br /> Address p‘ . cot_�(e-�-(uL ,r..& /Z- City/State/Zip E V LIZ - `C / 1 955a6 1 <br /> APPLICANT:^Owner _Owner's Agent .Contractor ____Contractors Agent Tenant(must provide o letter of consent from the owner to do work in the shore) <br /> i Q�� \ <br /> ��l�J ST� <br /> CONTRACTOR V �ri,..�i�����-- L&t Lic.# �� 7F tJCOE Bus.Lic. <br /> Address y, PAA t, Sr "! "' � Phone7E�ma0ii�Q,�fp-N.4 - Q�:�MZ S1/4. <br /> TENANT BUSINESS NAME CON \T FORMPERMIT �� ,,,,_-'`i�, <br /> Phone/E-mail SV f-.53T <br /> -T 1-- <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK ...stt e)-1.134 • ta+► <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: NewAddition Remodel —Repair—T.I.„^Sign Sprinkler Demolition^Change of Use <br /> DESCRIPTION OF WO K(additional space provided on the back): <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: <br /> , Number of Heads Other: <br /> t hereby certify that I have read and examined this application and know the same to be true and correct.Al provisions of laws and ordinances governing this type of work will be cornpfed <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 anti I comply with the State Contractors law 18.27 RCW and 298.200A WAC. <br /> Owner/Authorized Agen Signature Date (Revised&/2012) <br />