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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# <br /> 5+ IT# <br /> q91.7._ l pc. W Ev6Tr. wr't q9)2_(>4/ Ol DlZ000too � r♦p_02�- <br /> LEGAL for new construction: Short''Plat/subdivision (11-1(11-1-1 -T <br /> ' y L67rfT� Lot No. /I (attach copy of long legal description) <br /> OWNER C LisimS'CD,Jr IfhwtE4 iJtAJ LIC- Phone/E-mail 4125- <br /> -.538-561* /5?€C €- STpNF/loof us <br /> Address Po /3 oX I y clic, City/State/Zip 0121.4- Cg-t-e 4 WA q8O Si. <br /> APPLICANT:_Owner x Owners Agent _Contractor _Contractor's Agent _Tenant(must provide a letter of consent from the owner to do work in the space) <br /> CONTRACTOR COR/QE1ZS?C+^1E '14Ow1E. M9 LLC- L&I Lic.# (,o1R,A)4 NGS 47ok COE Bus. Lic.# 0,19 19 7 <br /> Address Po QOx /LiYZH MT Li—CAZEEN ,t,o4 R 2O 2- Phone/Email 14Z C-3313-5545t f CoLNtgSANEfibi%;CS V' <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT T <br /> J ? I�hvh17T^1C-' ' <br /> Phone/E-mail NZ;--33g-5-8138/spec.R IFg r.,404.w/ES•05 <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building NEW S IZ Gas X Electric Other <br /> Building type: �C 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 /> 61 <br /> (\lEtAi s-Ft -A ii- 2 <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 /> I Forced air systems 2- Bathtub <br /> Gas piping 4 Lavatory(wash basin) <br /> I Water heater I Shower <br /> I Gas fireplace I Kitchen sink&disposal <br /> / Gas range I Dishwasher <br /> 1 Clothes dryer I Clothes washer <br /> ( Range hood -; \Natta_he ter <br /> 5 Exhaust fan Sink(service/bar/mop/etc.) <br /> Heat pump Backflow preventer <br /> Unit heater Urinal <br /> Boiler Drinking Fountain <br /> IRefrigeration Floor drain <br /> Woodstove Grease trap <br /> • <br /> 1 Ducting Roof drains <br /> I Other Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM Other: <br /> Number of Heads Other: <br /> - <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 /> T t am authorized by owner of this property to perform the work for which a-pplication is made and I comply with the State Contractors Law 18.27 RCW and 298.200A WAC. <br /> O1rlAut razed Agent Signature / Date (Revised 6/2012) I <br />