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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# P€RMIT <br /> 3332 /'?oGk, 00i/36979Z 0170i 10-1--61), - <br /> LEGAL for new construction: Shorrt�Plat/subdivision Lot No. (attach copy of long legal description) <br /> CA,'OWNER f /"r__+//� Phone/E-mail 7'25 --328. 6 £9 7 <br /> Address 3332, Rd f�P TY��, G' Y City/State/Zip Ede,-,77 GHQ gg2 0 3 <br /> APPLICANT:_Owner Owner's Agent _Contractor i/Contractor's Agent _Tenant(must provide a letter of consent from the owner to do work in the space) <br /> CONTRACTOR ,)he/to-, /—'f 4 L&l Lic.#S!c/fF/!go R7 COE Bus.Lic.# <br /> Address P/8- `j--a//9 t leer ' 4, C 0- 1,,,40-'.;x11 Phone/Email �Zj- �Z�—6 L 7 <br /> TENANT BUSINESS AME � } CONTACT FOR PERMIT .S � <br /> /y� Sc o r4(10 b two. ?A h 2s--32g-6597 <br /> Phone/E-mail /7?S ��o C Oyrs sr s" <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK_ 3 0 0 0- `--� <br /> Existing Use of Building 4 yrk y e /Jc fT HEAT SOURCE: <br /> `• <br /> Proposed Use of Building_G /dLcJr Gas Electric Other <br /> Building type: 14.ingle Family _15uplex Townhouse <br /> Multi-Family Commercial <br /> Type of project: New _Addition _Remodel //Kepair_T.I._Sign Sprinkler Demolition Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): r en,a t✓e e X,S'' <br /> ct-gee - reP/qce w, site ' der h' s' <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 time and correct All provisions of laws and ordinances governing this type of work wit 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 /> Owner/Authorized Agent Signature Date (Revised 6/2012) <br />