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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:02 1,4 n 0Cic E CI`t.,)it 'PROPERTY TAX# IPERMIT <br /> # GOb <br /> LEGAL for new construction: Short Plat/subdivision _Lot No. (attach copy of long legal description) <br /> OWNER alticS ' (go& Phone/E-mail <br /> Address City/State/Zip <br /> APPLICANT:_Owner _Owner's Agent Contractorotrt _#Contractors Agent Tenant(must provide a letter of consent from the owner to do work In the space) <br /> CONTRACTOR "'�6 ..C(. .r L&I Lic.# COE Bus.Lic.# <br /> Address 011 l Phone/Email. <br /> TENANT BUSINESS NAME` c `� CONTACT FOR PERMIT 1 <br /> � � 1 AUL� G rl. '�S'-�(a 5-S�Qd4 � ai'7 ecs��lE �d got.,/.«,�. <br /> l/ 6�4 // 6( t/C/� ft/' Phone/E-mail TI�I61.r .)"Teesdale <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK ?,s ;) <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building Gas X Electric Other <br /> Building type: _Single Family _Duplex Townhouse _Multi-Family Commercial <br /> Type of project T New Addition _Remodel _Repair_T.1. . . Sign_Sprinkler Demolition Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> vQ 81011 ( ''II st >1 - non-(rt <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/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 autho by the owner of this property to perform the work for which application is made and I comply wth the tate Contractors Law 18.27 RCW end 298.200A WAC. <br /> z .sll Ag 3l t3 <br /> Owner/Authorized Agent Signature Da / vised 6/2012) <br />