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PERMIT APF UCATION <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# PERMIT# <br /> �r2c/ Ke4/0,.4 Avg 13o1- 02-0 <br /> LEGAL for new construction: Short Plat/subdivision _ _Lot No. (attach copy of long legal description) <br /> OWNER klic,y4 6,‘,1_4,46,4-1:-. ? Phone/E-mail V "�)T/- e i/ �:cf /L,1,--71 4e,h*re,).ti--i <br /> Address ..4,4.,t V,Zbyr(rf jAVr City/State/Zip <br /> ELii2TrrrZ (11,,4- �- <br /> APPLICANT: l/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 Coe ts-s GAJ Zt /oma CG i,� C L&I Lic.# ig ISG r/f O4 COE Bus. Lic. # <br /> Andress �O S /4i3td A✓E ,LJE /ACE Lrf:t4C,,JSLA 9 • s Phone/Email. , Q Ey/—//9c <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> y1S=y�Y 576 7.-cE-u-) <br /> Jcsrie'W 6944 fcei <br /> Phone.E-mail Cr•ZTcS a1-.Z. -2874'/ rcaz-) <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK 15.7(0 cio <br /> Existing Use of Building ,1 -jr HEAT SOURCE: <br /> Proposed Use of Building 4/'7= Gas i Electric Other <br /> Building type: ✓ Single Family Duplex_Townhouse Multi-Family Commercial <br /> Type of project: New Addition v Remodel Repair_T.I. Sign Sprinkler Demolition Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> kic0•640 lG/-x'11 eEA/21-1( 41ALG. <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New_Addn Alteration_Repair Type of Project: _New Addn Alteration_Repair <br /> S/tow Number(#)of fixtures Show Number(#)of fixtures <br /> A/C-air handling units Toilet <br /> Forced air systems I Bathtub <br /> Gas piping Lavatory(wash basin) <br /> Water heater I 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 i 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 I 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 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.di <br /> 0 n'/Authorized Agent Signature Date (Revised 6/2012) <br />