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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 /> 162i(D APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS: PROPERTY TAX# PERMIT# <br /> -/6 SE Ed 77" *Ace, �o a cry o D i 5O4 -O 2$ <br /> LEGAL for new construction: Short Plat/subdiviSion Lot No. (attach copy of long legal description) <br /> OWNER //U7 ,4L /ViL� Phone/E-mail <br /> Address j(/5 (/OODAAY' ,Svf1-6 204 City/State/Zip 0'e/ p-1- w� 96'203 <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 (�jP L&I Lic.# COE Bus. Lic.# <br /> Address Phone/Email <br /> TENANTB6 A BUSINESS NAME CONTACT FOR <br /> PERMIT ` <br /> c 1 c-1-00-4(55,- Jr,�G c�/ i n/ �aNYBS ,rm 19fi4K <br /> Phone/E-mail rjW0 ,vT%aUiNC JfibatekVe 1A7Wp(, <br /> BUILDING PERMIT APPLICATION- CONTRACT PRICE OF WORK (► (L(t ovt 04). <br /> eowo <br /> Existing Use of Building 't HEAT SOURCE: �l7— <br /> Proposed Use ofBuilding___ S2 - Lots 412,At21 S-byt, E Gas ElectricOther <br /> Buildingtype: Single Family Yp g Duplex Townhouse Multi-Family )(Commercial <br /> Type of project: X New Addition Remodel Repair T.I._Sign Sprinkler Demolition Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back) <br /> s>r. f c-ro2te- : ¶rc'04CT c ►' ss SF = (12m46 sr, <br /> ( ) 9--(1n..1 c-t120 Cc <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 heaterShower <br /> Gas fireplace _ <br /> rd Kitchen sink&disposal <br /> Gas range •,t-A, `(, 1Dishwasher <br /> Clothes dryerl �/`� Clothes washer <br /> Range hood / <br /> Water heater <br /> Exhaust fan Sink(service/bar/mop/etc.) <br /> Heat pump <br /> 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 /> 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 authorizedby 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 /> Aft(1- tkir bitb/r3 <br /> Owne/Autho to Agent Signature L., Gate (Revised 6/2012) <br /> �Iz <br />