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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.evereftwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS: PROPERTY TAX# PERMIT# <br /> 1g1D I NIrL-R(L1LA- PARyc1tiA- 2 S©Aca--to-4 -003-C,C, I -t--1) : f5, <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER AC.LjcllNO%rq .TAx-tt4E_S4µ1P Phone/E-mad4ZS,(p 98, 3S5 MIck12. QW11Z,000L. <br /> Address PO 64015 City/State/zip 04IC400 1L (oo(�,o&, <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 '-MV L&I Lic. # COE Bus. Lic. # <br /> Address Phone/Email <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT R C<< S <br /> Hf-�Avtt-! s�ru1.,E v� McER.RVu L?.e+c NN-2-11IIA Nltcr-- NPZq-.FGWw't►vN-Sl3�+�.c . <br /> Phone/E-mail Z.o(o,ZO4+04QV <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <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: New Addition Remodel Repair_T.1. Sign_Sprinkler_Demolition Change of Use <br /> DESCRIPTION OF WORK(additional space provic(ed on the back): <br /> L!)NS'rQ�Cr N EX'tF4LtoR. pRA��tt/ -ESS�k3�. FAN•IP ! IP4rT to AY Faors,-rm1= eros-rtNL► <br /> LLVQ,Ita+St To A"' f---" 1 M -6-S STcp )v6? (L"teU3e0 C-6ti- ADA- C a.y`PILs A a ) <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 /> AJC-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 slate 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 1827 RCW and 296.200A WAC. <br /> If `(;_�— <br /> Owner/Authorized Agent Signature Date (Revised 6/2012) <br />