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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# S S (..2A,---C PERMIT# <br /> Z-Fr4- Tra.7 ter Q r , -ve4.4- , t,J / oO N l 7000LooGoo 012-1 1 "O-=5 <br /> LEGAL for new construction: Short Plat/subdivision 110Z•- O/` - 0t , _Lot No. /I (attach copy of long legal <br /> description)^pt <br /> OWNER / 1,,,,s4---c— _i, Lo.w{L Leve(op✓fte✓!J- Phone/E-mail 4ZS z.94/ .5-31 ,�°�+ y",9441✓/f-hot(.S ne <br /> Address Pc) go), 12474 City/State/Zip ma/ Creek , iJ,4- 915-08z.-- <br /> APPLICANT: <br /> sogzAPPLICANT: V/Owner rr Owner's Agent _Contractor Contractor's Agent -Tenant(must provide a letter ofconsent from the owner todowork inthe space) <br /> CONTRACTOR • <br /> [� Dijov cd-Ort �004.e � /� p L& I Lic.# ..576A/4/14(1/74-1 :/ COE Buss. Lic. # <br /> Address Po (0)C (Z..I.7 Co , M llecce1 1 (,,,Jfj- 9 D Dwi-- Phone/Email C/Z.c Zq/q Ca-C479 <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> MO <br /> Phone/E-mail `IZS/2 401- aril <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK -. ;c ;_;q S <br /> Existing Use of Building / HEAT SOURCE: <br /> S <br /> Proposed Use of Building ..tn1G �e. f a/-1jc...7 SID.yt/G5. Gas .."--- Electric Other <br /> Building type: ✓ Single Family Duplex Townhouse _Multi-Family Commercial <br /> Type of project: ✓ New Addition Remodel _Repair T.I. Sign_Sprinkler Demolition Change of Use <br /> DESCRIPTION OF WORK(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 3 ' Toilet <br /> t Forced air systems 1, Z Bathtub !r ri <br /> 4 Gas piping kl j S Lavatory(wash basin) <br /> / Water heater 1 .-,._ Shower j/ <br /> / Gas fireplace c t Kitchen sink&disposal <br /> / Gas range I Dishwasher / <br /> / Clothes dryer 1I Clothes washer f <br /> Range hood - _! - _Water heater--_ <br /> 4, Exhaust fan Jar i _ 1 Sink(service/bar/mop/etc.) <br /> Heat pump Backflow preventer <br /> Unit heater Urinal <br /> Boiler Drinking Fountain <br /> Refrigeration i Floor drain — <br /> Woodstove Grease trap <br /> Ducting ! Roof drains <br /> I. 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 a nz d 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 /> 1 <br /> Owyi r/Authorized Age t Signature ate (Revised 6/2012) <br />